影响老年病人全身麻醉非心脏手术术后谵妄发生的因素

doi:10.16139/j.1007-9610.2024.06.09

摘要/Abstract

摘要：

目的： 探讨老年病人择期全身麻醉（全麻）下行非心脏手术术后谵妄的发生率及其相关因素。方法： 回顾2017年12月31日至2018年12月31日全麻下接受非心脏手术、年龄≥65岁的老年病人，根据手术后是否出现谵妄分为谵妄组和对照组。谵妄组和对照组两组病人的实验室检查指标进行配对t检验，应用Logistic回归分析，明确老年病人行非心脏手术后谵妄发生的独立危险因素。结果： 本研究共纳入1 072例择期行非心脏手术的老年病人，其中60例发生谵妄，谵妄发生率为5.6%。多因素Logistic回归分析结果显示，术后凝血酶原时间（PT）、术前血糖、术前活化部分凝血活酶时间（APTT）、术后C反应蛋白（CRP）是老年病人非心脏手术术后谵妄发生的独立危险因素。结论： 老年病人接受非心脏手术后，术后PT、术前血糖、术前APTT、术后CRP构成术后谵妄发生的独立危险因素。

关键词: 谵妄, 老年, 全身麻醉, 非心脏手术, 危险因素

Abstract:

Objective To investigate the incidence and related factors of postoperative delirium in elderly patients undergoing elective noncardiac surgery under general anesthesia. Methods Elderly patients aged ≥65 years old undergoing non-cardiac surgery under general anesthesia from December 31, 2017 to December 31, 2018 were retrospectively analyzed. The patients were divided into delirium group and control group according to whether delirium occurred after surgery. Paired t test was used to compare the laboratory test results between the delirium group and the control group. Logistic regression analysis was used to identify the independent risk factors for delirium after non-cardiac surgery in elderly patients. Results A total of 1 072 elderly patients undergoing elective non-cardiac surgery were enrolled in this study. Delirium occurred in 60 patients, and the incidence of delirium was 5.6%. Multivariate Logistic regression analysis showed that postoperative prothrombin time(PT), preoperative blood glucose, preoperative activated partial thromboplastin time(APTT) and postoperative C-reactive protein(CRP) were independent risk factors for delirium after non-cardiac surgery in elderly patients. Conclusions Postoperative PT, preoperative blood glucose, preoperative APTT and postoperative CRP are independent risk factors for POD in elderly patients undergoing non-cardiac surgery.

Key words: Delirium, Old population, General anesthesia, Non-cardiac surgery, Risk factor

中图分类号:

R592
R614.2

吴昕菀, 李响, 郑旻嘉, 姚俊岩. 影响老年病人全身麻醉非心脏手术术后谵妄发生的因素[J]. 外科理论与实践, 2024, 29(06): 510-517.

WU Xinwan, LI Xiang, ZHENG Minjia, YAO Junyan. Risk factors of postoperative delirium in elderly patients undergoing noncardiac surgery under general anesthesia[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 510-517.

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General Information	Delirium group （n=60）	Control group （n=60）
Age（years）	78.8±8.430	78.1±8.486
Gender
Female	35	35
Male	25	25
Diagnosis and surgical methods
Orthopedics surgery
Diseases related to the cervical spine	10	10
Lower extremity fractures	24	24
Lumbar disc herniation	6	6
Arthritis of the knee	1	1
Tumors of bone	1	1
Urology surgery	5	5
Tumor of the ureter	2	2
Bladder neoplasms	3	3
Thoracic surgery	10	10
Lung cancer	6	6
Esophageal cancer	4	4
General surgery	3	3

Indicator	Delirium group	Control group	t value	P value
Blood electrolytes
K⁺ （mmol/L）	4.359±0.071	4.477±0.069	-1.164	0.249
Na⁺ （mmol/L）	140.636±0.547	140.563±0.546	0.104	0.917
Cl^- （mmol/L）	99.045±0.440	99.090±0.437	-0.069	0.946
Blood routine
Hb（g/L）	126.680±15.470	109.98±1.960	1.103	0.275
HCT（%）	40.280±0.290	40.196±0.292	0.197	0.845
White cells（×10⁹/L）	9.438±0.096	9.573±0.109	-0.909	0.367
Routine coagulation
PT （s）	12.576±0.154	12.618±0.174	-0.198	0.844
APTT（s）	29.600±0.497	31.345±0.486	-2.206	0.031
Glucose（mmol/L）	5.756±0.212	6.348±0.298	-2.401	0.020
Blood lipids
Triglyceride（mmol/L）	1.264±0.090	1.313±0.076	-0.442	0.660
Cholesterol （mmol/L）	4.294±0.112	4.708±0.140	-2.204	0.031
Renal function
Creatinine （μmol/L）	86.840±13.113	69.565±2.649	1.286	0.204
BUN （mmol/L）	7.530±0.161	7.270±0.144	1.271	0.209
Liver function
AST （U/L）	24.416±0.759	24.816±0.838	-0.326	0.746
ALT （U/L）	26.133±0.764	24.923±0.784	1.195	0.237
Albumin （g/L）	41.086±0.486	40.465±0.493	0.897	0.373
CRP（mg/L）	19.408±0.345	17.73±0.784	0.357	0.759

Indicator	Delirium group	Control group	t value	P value
Blood electrolytes
K⁺ （mmol/L）	4.194±0.073	4.200±0.073	-0.054	0.957
Na⁺ （mmol/L）	140.68±0.050	140.545±0.050	0.209	0.835
Cl^- （mmol/L）	100.050±0.411	100.028±0.413	0.035	0.972
Blood routine
Hb（g/L）	107.150±1.950	105.350±1.740	0.704	0.484
HCT（%）	41.156±0.303	41.011±0.347	0.328	0.744
White cells（×10⁹/L）	10.855±0.093	10.616±0.110	1.615	0.112
Routine coagulation
PT （s）	12.415±0.099	13.016±0.123	-3.850	0.000
APTT（s）	30.143±0.510	31.373±0.556	-1.472	0.146
Glucose（mmol/L）	7.042±0.330	6.753±0.220	0.793	0.431
Blood lipids
Triglyceride（mmol/L）	1.233±0.066	1.161±0.063	0.902	0.371
Cholesterol （mmol/L）	3.694±0.115	4.378±0.135	-3.757	0.000
Renal function
Creatinine （μmol/L）	90.014±14.368	65.990±3.012	1.636	0.107
BUN （mmol/L）	7.856±0.162	7.676±0.154	0.801	0.426
Liver function
AST （U/L）	25.450±0.764	26.350±0.824	-0.923	0.360
ALT （U/L）	26.166±0.671	26.383±0.784	-0.214	0.831
Albumin （g/L）	41.478±0.326	39.951±0.663	2.094	0.041
CRP（mg/L）	63.542±50.211	32.843±10.415	3.642	0.001

Indicator	Before surgery	After surgery	t value	P value
Blood electrolytes
K⁺ （mmol/L）	4.359±0.071	4.194±0.073	1.544	0.128
Na⁺ （mmol/L）	140.636±0.547	140.680±0.050	-0.123	0.903
Cl^- （mmol/L）	99.045±0.440	100.050±0.411	-2.152	0.036
Blood routine
Hb（g/L）	126.680±15.470	107.150±1.950	1.271	0.209
HCT（%）	40.280±0.290	41.156±0.303	-2.400	0.020
White cells（×10⁹/L）	9.438±0.096	10.855±0.093	-10.931	0.000
Routine coagulation
PT （s）	12.576±0.154	12.415±0.099	0.864	0.391
APTT（s）	29.600±0.497	30.143±0.510	-1.767	0.082
Glucose（mmol/L）	5.756±0.212	7.042±0.330	-3.913	0.000
Blood lipids
Triglyceride（mmol/L）	1.264±0.090	1.233±0.066	0.624	0.535
Cholesterol （mmol/L）	4.294±0.112	3.694±0.115	6.692	0.000
Renal function
Creatinine （μmol/L）	86.840±13.113	90.014±14.368	-1.429	0.158
BUN （mmol/L）	7.530±0.161	7.856±0.162	-2.948	0.005
Liver function
AST （U/L）	24.416±0.759	25.450±0.764	-1.195	0.237
ALT （U/L）	26.133±0.764	26.166±0.671	-0.048	0.962
Albumin （g/L）	41.086±0.486	41.478±0.326	-0.966	0.338
CRP（mg/L）	19.408±0.345	63.542±50.211	-6.808	0.000

	B	SE	Wald	P value	OR	OR 95% confidence interval
	B	SE	Wald	P value	OR	Lower limit	Upper limit
Postoperative albumin	0.131	0.065	4.019	0.045	1.140	1.003	1.296
Postoperative PT	-0.789	0.229	11.902	0.001	0.454	0.290	0.711
Preoperative APTT	-0.123	0.051	5.750	0.016	0.884	0.800	0.978
Preoperative glucose	-0.226	0.101	4.993	0.025	0.798	0.655	0.973
Preoperative cholesterol	-0.400	0.194	4.266	0.039	0.670	0.458	0.980
Postoperative cholesterol	-0.785	0.221	12.554	0.000	0.456	0.296	0.704
Postoperative creatinine	0.015	0.007	4.384	0.036	1.015	1.001	1.029
Postoperative CRP	0.013	0.004	7.903	0.005	1.013	1.004	1.022
History of diabetes	1.449	0.601	5.819	0.016	4.261	1.312	13.834