摘要
目的分析老年患者术后谵妄的危险因素,探究体重指数（BMI）与老年患者术后谵妄的关系。方法本研究为前瞻、观察性队列研究。2011年5月至2013年11月全身麻醉下接受非心脏手术后入ICU的老年患者350例,年龄≥65岁。使用CAM-ICU法每天2次评估术后7d内谵妄发生情况。使用Logistic多因素回归分析评估术后谵妄的危险因素。结果共79例（22.6%）患者发生术后谵妄。参照WHO亚洲人BMI参考标准,将患者分为偏瘦（BMI〈18.5kg/m^2）、正常（BMI18.5～22.9kg/m^2）、偏胖（BMI 23.0～24.9kg/m^2）、肥胖（BMI 25.0～29.9kg/m^2）、重度肥胖（BMI≥30.0kg/m^2）5个等级,将BMI分级代入Logistic多因素回归模型,结果显示与正常BMI者比较,偏瘦者术后谵妄风险增加（OR 2.551,95%CI 1.101～5.909,P=0.029）,而偏胖、肥胖与重度肥胖者不增加术后谵妄风险。对BMI进行ROC曲线分析,得出谵妄风险增加的拐点BMI为20.0kg/m^2,根据此拐点将BMI转换为二分类变量并代入Logistic多因素回归模型,结果显示BMI〈20.0kg/m^2者术后谵妄发生风险明显增加（OR 2.679,95%CI 1.438～4.990,P=0.001）。结论对于非心脏手术后进入ICU的老年患者,低体重指数（BMI〈20.0kg/m^2）是增加术后谵妄风险的独立危险因素之一。
Objective To investigate the risk factors associated with increased risk of delirium and explore the association between body mass index（BMI）and the occurrence of delirium in elderly patients after noncardiac surgery.Methods A total of 350 elderly patients（≥65years）who were admitted to the intensive care unit（ICU）after noncardiac surgery were enrolled.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU（CAM-ICU）during the first 7days after surgery.Multivariate Logistic regression analysis was performed to assess the relationship between BMI and the occurrence of postoperative delirium.Results Postoperative delirium occurred in 22.6%（79of 350）of patients.Patients were divided into 5levels including underweight（BMI〈18.5kg/m^2）,normal（BMI 18.5-22.9kg/m^2）,overweight（BMI 23.0-24.9kg/m^2）,obesity（BMI25.0-29.9kg/m^2）and severe obesity（BMI≥30.0kg/m^2）according to the WHO reference standard of BMI in Asians.Multivariate Logistic regression analysis showed that compared with patients of normal BMI,underweight increased the risk of postoperative delirium（OR 2.551,95% CI 1.101-5.909,P=0.029）,however,overweight,obesity and severe obesity were not significantly associated with the occurrence of postoperative delirium.We found the inflection of BMI which increased risk of deliriumis was 20.0kg/m^2 by ROC curve analysis thus we converted BMI into dichotomous variable and multivariate Logistic regression analysis showed that BMI〈20.0kg/m^2 was significantly associated with increased risk of the occurrence of postoperative delirium（OR 2.679,95%CI 1.438-4.990,P=0.001）.Conclusion Low BMI（BMI〈20.0kg/m^2）is one of independent risk factors associated with increased risk of delirium in elderly patients after surgery.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第5期421-426,共6页
Journal of Clinical Anesthesiology
关键词
老年
体重指数
谵妄
危险因素
Ederly
Body mass index
Delirium
Risk factor
