老年患者颈椎手术后发生谵妄的危险因素分析

Analysis of risk factors for delirium after cervical spinal operation in elderly patients

中文关键词:  老年人  颈椎手术  术后谵妄  危险因素

英文关键词:Elderly  Cervical spine surgery  Delirium  Risk factors

中文摘要:

  【摘要】 目的：探讨老年患者颈椎手术后发生谵妄的危险因素。方法：回顾性分析2019年1月~2022年10月于我院骨科行颈椎手术治疗的252例老年患者的临床资料，其中男148例，女104例，平均年龄68.9±6.1岁（60~91岁）。根据意识模糊评估法（confusion assessment method，CAM）评估患者术后7d内是否发生谵妄，将患者分为谵妄组和非谵妄组。收集患者年龄、性别、疾病类型、吸烟史、饮酒史、合并症、体重指数（body mass index，BMI）、骨密度（bone mineral density，BMD）、睡眠障碍史、圣路易斯大学精神状态（Saint Louis University Mental Status，SLUMS）评分、手术入路、美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、术前红细胞压积和电解质浓度、术前和术后1d血红蛋白和白蛋白水平、手术时间、麻醉时间、失血量、术后是否进入ICU及术后3d内低氧血症、低血压发生等情况；麻醉相关药物使用情况，包括抗胆碱药物、苯二氮卓类药物、右美托咪定等；术前及术后3d采用视觉模拟评分量表（visual analogue scale，VAS）评估疼痛状态、日本骨科协会（Japanese Orthopaedic Association，JOA）评分和颈椎功能障碍指数（neck disability index，NDI）评价颈椎功能。通过独立样本t检验或χ2检验分析两组间差异，对两组间有差异的指标采用二元Logistic回归方法分析患者术后发生谵妄的危险因素。结果：颈椎手术后发生谵妄者31例，未发生谵妄者221例，术后谵妄发生率12.3%。单因素分析结果显示年龄、脑卒中病史、帕金森病、肺部疾病、睡眠障碍史、SLUMS评分、术前白蛋白水平、手术时间、麻醉时间、失血量、术后白蛋白水平、术后入住ICU、术后低氧血症等13个因素在谵妄组与非谵妄组间差异存在统计学意义（P＜0.05）；性别、疾病类型、吸烟史、饮酒史、高血压、糖尿病、BMI、BMD、手术入路、ASA分级、术前和术后VAS评分、JOA评分、NDI及血红蛋白水平、术前红细胞压积和电解质浓度、抗胆碱药物、苯二氮卓类药物、右美托咪定的使用在两组间无统计学差异（P＞0.05）。多因素Logistic回归分析结果显示年龄≥70岁（OR=2.844，P=0.031）、脑卒中病史（OR=3.476，P=0.012）、帕金森病（OR=18.815，P=0.003）、肺部疾病（OR=7.213，P=0.000）、睡眠障碍史（OR=3.010，P=0.025）、SLUMS评分≤21分（OR=4.529，P=0.012）、术后进入ICU（OR=4.131，P=0.005）是颈椎手术后发生谵妄的危险因素。结论：年龄≥70岁、脑卒中病史、帕金森病、肺部疾病史、睡眠障碍史、SLUMS评分≤21分、术后进入ICU是老年患者颈椎手术后发生谵妄的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors of postoperative delirium in elderly patients after cervical spine operation. Methods: The clinical data of 252 elderly patients treated with cervical spine surgery in our hospital from January 2019 to October 2022, including 148 males and 104 females, with a mean age of 68.9±6.1 years(60-91 years) old were retrospectively analyzed. The Confusion Assessment Method (CAM) was utilized to assess whether the patients exhibited delirium after surgery in a week, and they were divided into delirium group and non-delirium group. Data were collected, such as age, sex, disease type, smoking history, drinking history, comorbidities, body mass index(BMI), bone mineral density(BMD), sleep disorders, the Saint Louis University Mental Status(SLUMS) score, surgical approach, American Society of Anesthesiologists(ASA) grade, preoperative hematocrit and electrolytes concentration, preoperative and postoperative 1d hemoglobin and albumin levels, operative time, anesthesia time, blood loss, postoperative hospitalization in ICU, the occurrence of postoperative hypoxaemia and postoperative hypotension within 3 days; Narcotics-related drug use included: anticholinergics, benzodiazepines, dexmedetomidine; Before operation and at 3d after operation, visual analogue scale(VAS) was used to evaluate the pain status, and Japanese Orthopaedic Association(JOA) score and neck disability index(NDI) were adopted to assess the cervical function. The differences between the two groups were analyzed with independent sample t-test or χ2 test, and indexes with intergroup difference were analyzed with the binary logistic regression method to determine the risk factors for delirum after operation. Results: There were 31 patients with postoperative delirium and 221 patients without delirium. Univariate analysis showed that age, stroke history, Parkinson′s disease, pulmonary disease, sleep disorder, SLUMS score, preoperative albumin level, operative time, anesthesia time, blood loss, postoperative albumin level, postoperative hospitalization in ICU and postoperative hypoxemia were with statistically significant differences between delirium group and non-delirium group(P<0.05); Sex, disease type, smoking history, drinking history, hypertension, diabetes, BMI, BMD, surgical approach, ASA grade, preoperative and postoperative VAS scores, JOA scores, NDI, and hemoglobin levels, preoperative hematocrit, electrolyte concentration, and the use of anticholinergics, benzodiazepines, and dexmedetomidine were not statistically different between the two groups(P>0.05). The multivariate logistic regression analysis showed age≥70 years(OR=2.844, P=0.031), stroke history(OR=3.476, P=0.012), Parkinson′s disease(OR=18.815, P=0.003), pulmonary disease(OR=7.213, P=0.000), sleep disorders(OR=3.010, P=0.025), SLUMS score≤21(OR=4.529, P=0.012), and postoperative hospitalization in ICU(OR=4.131, P=0.005) were the risk factors for delirium after cervical spinal operation. Conclusions: Elderly patients who age≥70 years, have stroke history, Parkinson′s disease, pulmonary disease, sleep disorders, SLUMS score≤21, and are hospitalized in ICU after operation are prone to delirium after operation in cervical spine.