摘要
目的探讨成人胶质瘤的恶性程度对患者术后谵妄发生的影响因素。方法对2017年3月至2018年2月首都医科大学附属北京天坛医院重症医学科(ICU)进行的一项纳入800例神经外科患者的单中心、前瞻性队列研究中的113例成人胶质瘤患者的临床数据进行二次分析。患者于术后第1天至第3天(每日2次)采用Richmond躁动-镇静评分(RASS)和ICU意识模糊评估法(CAM-ICU)进行谵妄评估。以患者是否发生谵妄分为谵妄组(43例)和非谵妄组(70例)。采集患者的术前一般资料、术中情况、术后早期临床资料以及神经外科专科资料[含世界卫生组织(WHO)分级]作为与术后谵妄发生可能有关的潜在危险因素。采用多因素logistic回归分析明确术后谵妄的独立危险因素,尤其是明确胶质瘤WHO分级与术后谵妄发生的关系。结果113例入住ICU行常规术后监护的胶质瘤患者中,术后谵妄的发生率为38.1%(43/113)。WHOⅠ~Ⅳ级胶质瘤患者的术后谵妄发生率随着WHO级别的升高而升高,分别为7.7%(1/13)、14.3%(3/21)、22.7%(5/22)以及63.0%(34/57)。潜在的危险因素中,年龄(OR=1.08,95%CI:1.04~1.13,P<0.001)、入住ICU时的格拉斯哥昏迷评分(OR=0.80,95%CI:0.71~0.90,P<0.001)以及肿瘤的WHO分级(OR=2.01,95%CI:1.03~3.92,P=0.041)为患者术后谵妄的独立危险因素。结论胶质瘤的恶性程度为术后谵妄的独立危险因素,并且随着肿瘤级别的升高,术后谵妄的发生率亦随之升高。
Objective To analyze the incidence and risk factors of postoperative delirium(POD)in patients with glioma and to explore the association between WHO(World Health Organization)tumor grades and POD.Methods A second analysis of clinical data from 113 adult glioma patients in a single-center,prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine(ICU),Beijing Tiantan Hospital,Capital Medical University.Patients were assessed for delirium on the first to third days post surgery(twice a day)using the Richmond Agitation-Sedation Scale(RASS)and Confusion Assessment Method for the ICU(CAM-ICU).The patient was divided into delirium group(43 cases)and non-delirium group(70 cases)by whether the patient had had delirium.We collected the patient’s general preoperative information,preoperative condition,early postoperative clinical data,and neurosurgical specialty data(including WHO grades)as potential risk factors that may be associated with the occurrence of POD.The independent risk factors of POD were identified using multivariate logistic regression analysis.In particular,the relationship between WHO glioma grade and POD was explored.Results In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring,the incidence of POD was 38.1%(43/113).The incidence of POD in patients with WHO gradeⅠ-Ⅳgliomas increased with the increase of the WHO grade:7.7%(1/13),14.3%(3/21),22.7%(5/22)and 63.0%(34/57).Among the potential risk factors,age(OR=1.08,95%CI:1.04-1.13,P<0.001),GCS(Glasgow coma scale)score at admission to ICU(OR=0.80,95%CI:0.71-0.90,P<0.001)and the WHO grade of tumor(OR=2.01,95%CI:1.03-3.92,P=0.041)was independent risk factors for POD.Conclusions The WHO grade of glioma is an independent risk factor for POD.With the increase of tumor grade,the incidence of POD also increases.
作者
黄华玮
张国滨
张小康
王春梅
陈静然
王玉妹
徐明
林松
周建新
Huang Huawei;Zhang Guobin;Zhang Xiaokang;Wang Chunmei;Chen Jingran;Wang Yumei;Xu Ming;Lin Song;Zhou Jianxin(Department of Intensive Care Unit,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第3期258-263,共6页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(81801042)
北京市医院管理中心"青苗"计划专项经费资助(QML20190504)
首都医科大学科研培育基金(PYZ19113)。
关键词
神经胶质瘤
神经外科手术
谵妄
肿瘤分级
神经代偿重塑
Glioma
Neurosurgical procedures
Delirium
Neoplasm grading
Compensa-tory neuroplasticity
