摘要
目的探讨成人脑胶质瘤患者术后发生谵妄的影响因素及其预测价值。方法选取2017-01-01-2019-12-31天津医科大学总医院收治的139例脑胶质瘤患者为研究对象。采用简易智力状况检查量表(MMSE)评估患者术前认知状况,采用格拉斯哥昏迷评分(GCS)评估患者术前昏迷程度,按照美国麻醉医师协会(ASA)标准进行麻醉分级,根据2016年WHO中枢神经系统肿瘤分类指南进行肿瘤分级,术后6 h内常规行头颅CT检查,采用重症监护意识模糊评估法(CAM-ICU)检查谵妄,并根据检查结果将研究对象分为谵妄组(52例)和非谵妄组(87例)。酶联免疫吸附法(ELISA)检测患者术后1 d血清Netrin-1水平,记录患者受教育程度、高血压、糖尿病、饮酒史、肿瘤直径和术后颅内缺血等资料,进行组间比较,采用病例对照分析影响脑胶质瘤患者术后发生谵妄的因素。绘制受试者工作特征(ROC)曲线评估模型对谵妄的预测价值。结果谵妄组与非谵妄组相比,年龄、受教育程度、高血压、术中输血、肿瘤直径、WHO分级、术后颅内缺血和肿瘤部位差异均有统计学意义,均P<0.05;与非谵妄组相比,谵妄组血清Netrin-1水平较高,t=7.376,P<0.001。年龄≥50岁(OR=2.113,95%CI为1.566~2.852)、Ⅲ~Ⅳ级WHO肿瘤分级(OR=2.528,95%CI为1.475~4.334)、额叶肿瘤(OR=2.267,95%CI为1.164~4.414)和Netrin-1高水平(OR=2.148,95%CI为1.251~3.690)均是影响脑胶质瘤患者术后发生谵妄的危险因素,均P<0.05。Hosmer-Lemeshow检验显示,风险预测模型具有较好拟合度,χ^(2)=9.271,P=0.495。经ROC验证显示曲线下面积(AUC)为0.685(95%CI为0.486~0.885),约登指数最大值为0.419,此时对应的灵敏度为69.20%,特异度为72.70%。结论术后发生谵妄的脑胶质瘤患者血清Netrin-1水平较高,预测模型可能为脑胶质瘤术后谵妄的诊治提供临床参考依据。
Objective To investigate the influencing factors and predictive value of postoperative delirium in adult patients with glioma.Methods Totally 139patients with glioma in General Hospital of Tianjin Medical University from January1,2017to December 31,2019were selected as the study objects.The preoperative cognitive status was assessed by Mini Mental State Examination scale(MMSE),the degree of preoperative coma was evaluated by Glasgow Coma Scale(GCS),anesthesia was graded by the American Society of anesthesiologists(ASA),and the tumor was graded by the WHO guidelines for classification of central nervous system tumors in 2016.The head CT was performed within 6hours after the operation,delirium was examined by the Confusion Assessment Method for the ICU(CAM-ICU),and according to the examination results,the subjects were divided into delirium group(52cases)and non-delirium group(87cases).The level of Netrin-1at 1day after operation was detected by enzyme-linked immunosorbent assay(ELISA).In addition,the education level,hypertension,diabetes,drinking history,operation time,intraoperative blood transfusion,intraoperative hypotension,tumor diameter and postoperative intracranial ischemia were recorded and compared among groups;case-control analysis was used to study the factors affecting the occurrence of delirium in patients with glioma;the ROC curve was drawn to evaluate the predictive value of the model for delirium.Results There were significant differences in age,education level,hypertension,intraoperative blood transfusion,tumor diameter,WHO grade,postoperative intracranial ischemia and tumor location between delirium group and non-delirium group(P<0.05);compared with non-delirium group,the level of serum Netrin-1in delirium group was higher(t=7.376,P<0.001);age≥50years old,gradeⅢ-ⅣWHO tumor grade,frontal lobe tumors and high level of Netrin-1were all risk factors for postoperative delirium in patients with glioma(OR=2.113,95%CI:1.566-2.852;OR=2.528,95%CI:1.475-4.334;OR=2.267,95%CI:1.164-4.414;OR=2.148,95%CI
作者
贾源
周忆频
王增光
JIA Yuan;ZHOU Yi-pin;WANG Zeng-guang(Department o f Neurosurgery,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Neurosurgery,General Hospital of Tianjin Medical University,Tianjin 300052,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2021年第19期1477-1481,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
天津市教委科研计划(2018ZD03)。
