摘要
目的评价脊柱手术老年患者术后谵妄(POD)与术前衰弱的关系。方法择期全麻下行腰后路减压植骨融合内固定术患者220例,年龄≥65岁,性别不限,ASA分级Ⅱ-Ⅳ级。术前1 d采用衰弱筛查量表评估衰弱发生情况。术后3 d内每天2次采用意识模糊评估法评估POD发生情况。根据术后3 d内是否发生POD,将患者分为POD组和非POD组。采用多因素logistic回归分析筛选脊柱手术老年患者POD的危险因素,通过受试者工作特征曲线分析术前衰弱对POD的预测价值。结果最终纳入190例患者,术前衰弱55例,发生率为29.0%;POD 46例,发生率为24.2%。多因素logistic回归分析结果显示,年龄增加(OR=1.15,95%CI 1.03~1.29,P=0.017)、术前衰弱(OR=2.35,95%CI 1.24~4.43,P=0.009)、手术节段增多(OR=4.14,95%CI 1.71~10.05,P=0.002)和术后24 h疼痛VAS评分升高(OR=1.38,95%CI 1.07~1.78,P=0.013)是脊柱手术老年患者POD的独立危险因素。术前衰弱预测POD的曲线下面积为0.702(95%CI 0.608~0.796,P<0.001)。结论术前衰弱是脊柱手术老年患者POD的独立危险因素。术前衰弱可在一定程度上预测脊柱手术老年患者POD的发生。
Objective To evaluate the relationship between postoperative delirium(POD)and preoperative frailty in elderly patients undergoing spinal surgery.Methods Two hundred and twenty patients of both sexes,aged≥65 yr,of American Society of Anesthesiologists Physical Status classificationⅡ-Ⅳ,undergoing elective posterior lumbar decompression,bone grafting and internal fixation under general anesthesia,were selected.Frailty was measured using the FRAIL(fatigue,resistance,ambulation,illness,and loss of weight)scale on 1 day before surgery.POD was assessed twice a day within 3 days by Confusion Assessment Method.Patients were divided into POD group and non-POD group according to whether POD occurred within 3 days after surgery.Multivariate logistic regression analysis was used to identify the risk factors for POD in elderly patients undergoing spinal surgery,and the value of preoperative frailty in predicting POD was analyzed using the receiver operating characteristic curve.Results A total of 190 patients were finally enrolled,among which 55 patients presented with frailty before surgery,and the incidence was 29.0%.Forty-six patients developed POD,and the incidence was 24.2%.Multivariate logistic regression analysis showed that aging(OR=1.15,95%confidence interval[CI]1.03-1.29,P=0.017),preoperative frailty(OR=2.35,95%CI 1.24-4.43,P=0.009),increase in surgical segments(OR=4.14,95%CI 1.71-10.05,P=0.002)and increase in postoperative 24-h pain VAS score(OR=1.38,95%CI 1.07-1.78,P=0.013)were independent risk factors for POD in elderly patients undergoing spinal surgery.The area under receiver operating characteristic curve of preoperative frailty in predicting POD was 0.702(95%CI 0.608-0.796,P<0.001).Conclusions Preoperative frailty is an independent risk factor for POD in elderly patients undergoing spinal surgery.Preoperative frailty can predict the occurrence of POD in elderly patients undergoing spinal surgery to some extent.
作者
赵月凯
赵爽
刘欣
李金茹
贺恬怡
李昭
李惠洲
吴川
王秀丽
Zhao Yuekai;Zhao Shuang;Liu Xin;Li Jinru;He Tianyi;Li Zhao;Li Huizhou;Wu Chuan;Wang Xiuli(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2023年第6期688-691,共4页
Chinese Journal of Anesthesiology
基金
河北省重点研发计划项目(21377782D)。
关键词
谵妄
手术后并发症
衰弱
老年人
Delirium
Postoperative complications
Frailty
Aged
