摘要
目的探讨老年患者非心脏术后谵妄与乙酰胆碱酯酶活性及临床常用炎症指标之间的关系。方法选取2016年10月至2017年12月全身麻醉下非心脏手术后转入外科ICU患者106例,其中发生术后谵妄者45例(病例组),没有发生者61例(对照组);使用ICU患者意识模糊评估量表(CAM-ICU)评估入科术后患者,2次/d。分析老年患者术后谵妄发生与乙酰胆碱酯酶活性及白细胞(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、白介素1β(IL-1β)、白介素6(IL-6)等炎症指标的关系,采用病例-对照研究发现方法比较与术后发生谵妄有关联的危险因素。结果两组基线资料差异无统计学意义(P>0.05),两组急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、PCT、乙酰胆碱酯酶活性、IL-1β差异有统计学意义(P<0.05)。将P<0.1的危险因素进行二元Logistic回归分析,发现APACHEⅡ评分(OR=1.131,95%CI:1.011~1.268,P=0.032)和IL-1β(OR=4.209,95%CI:1.528~11.592,P=0.005)是老年患者发生术后谵妄的独立危险因素,而乙酰胆碱酯酶活性增加(OR=0.678,95%CI:0.519~0.886,P=0.004)是老年患者术后减低发生谵妄的保护性因素。结论老年患者术后谵妄的发生与疾病严重程度密切相关。IL-1β以及乙酰胆碱酯酶活性降低是老年患者发生术后谵妄的独立危险因素。积极控制炎症、改善乙酰胆碱酯酶活性有利于预防或减少老年病人术后谵妄的发生,为临床诊疗策略的制定提供了新的思路。
Objective To analyze the relationship among plasma acetylcholinesterase activity,inflammatory factors and postoperative delirium in patients who underwent noncardiac surgery.Methods A total of 106 patients transferred to SICU after non-cardiac surgery under general anesthesia during Oct.2016 and Dec.2017 were divided into the postoperative delirium group(n=45,case group)and control group(n=61).Delirium was assessed twice daily with the Confusion Assessment Method-Intensive Care Unit(CAM-ICU).The relationship among postoperative delirium,acetylcholinesterase activity and inflammatory factors such as leukocytes procalcitonin(PCT),C-reactive protein(CRP),IL-1βand IL-6 were analyzed.Results There were no statistical difference in baseline data between the two groups,while the APACHEⅡscore,PCT,acetylcholinesterase activity and IL-1βwere statistically different(P<0.05).Binary Logistic analysis revealed that APACHEⅡscore(OR=1.131,95%CI:1.011-1.268,P=0.032),and IL-1β(OR=4.209,95%CI:1.528-11.592,P=0.005)were independent risk factors of postoperative delirium,while increased acetylcholinesterase activity(OR=0.678,95%CI:0.519-0.886,P=0.004)was a protective factor.Conclusion Postoperative delirium in elderly patients is closely related to the severity of disease.IL-1βand decreased acetylcholinesterase activity are independent risk factors of postoperative delirium.Treatment of inflammation and improvement of acetylcholinesterase activity are beneficial to prevent or reduce the occurrence of postoperative delirium,which provides a new idea for the clinical diagnosis and treatment strategies.
作者
邢志群
李德军
赵宝
许春阳
纪洪生
XING Zhiqun;LI Dejun;ZHAO Bao;XU Chunyang;JI Hongsheng(DepartmentⅢof Critical Care Medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2021年第3期92-97,102,共7页
Journal of Shandong University:Health Sciences
基金
山东省重点研发计划(2015GGH318009)。
关键词
术后谵妄
老年患者
乙酰胆碱酯酶活性
炎症指标
Postoperative delirium
Elderly patients
Acetylcholinesterase activity
Inflammatory factors
