老年患者脊柱手术术后谵妄危险因素分析的回顾性研究 |
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投稿时间:2018-11-03 修订日期:2019-05-24
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期刊信息:《中国骨伤》年,第卷,第期,第-页 |
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中文摘要:目的 探讨老年患者脊柱手术术后谵妄的发生率及相关危险因素分析。方法 采用回顾性分析收集我院2016年1月-2018年11月收治的老年患者脊柱手术病例436例,根据术后是否发生谵妄分为谵妄组和非谵妄组;记录患者的性别、年龄、体重指数(bodymass index,BMI)、糖尿病史、冠心病史、慢性阻塞性肺疾病史(COPD)、术前白细胞计数、术前红细胞比容、术前血红蛋白水平、手术方式、手术时间、麻醉时间、美国麻醉医师协会(ASA)评分、心功能分级(NYHA)、术中失血量、术中输血量、术中芬太尼、异丙酚和地佐辛的用量、术后白细胞计数、术后红细胞比容、术后血红蛋白水平、术后电解质(钠离子、钾离子);单因素logistic回归分析有统计学意义的危险因素后进行多元Logistic回归分析进一步探讨独立危险因素。结果 纳入436例病例中112例老年患者术后出现谵妄,发生率约25.68%;谵妄组与非谵妄组在年龄、术前白细胞计数、术前红细胞比容、术后红细胞比容、术后血红蛋白水平、术后钠离子浓度、麻醉时间、ASA评分、心功能分级、术中失血量、术后地佐辛使用量、糖尿病史、冠心病史、COPD史方面有统计学差异(P<0.05);通过多因素logistic回归分析显示:年龄、ASA评分、术后地佐辛量、COPD史是老年患者脊柱手术术后谵妄发生的独立危险因素。结论 患者高龄>72岁、ASA评分>2分、地佐辛镇痛药物的使用以及患者合并COPD是术后谵妄发生的独立危险因素。 |
【关键词】脊柱手术 谵妄 危险因素 老年人 |
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A retrospective study on risk factors associated with postoperative delirium in elderly patients with Spinal operation |
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ABSTRACT Objective To investigate the incidence and risk factors of delirium after spinal surgery in elderly patients. Methods A retrospective analysis was performed on 436 patients with spinal surgery in our hospital from January 2016 to November 2018. According to whether delirium occurred after the operation, 436 cases were divided into two groups: delirium group and non-delirium group. Body mass index (body mass index,BMI), history of diabetes, history of coronary heart disease, history of chronic obstructive pulmonary disease (COPD), preoperative white blood cell count, preoperative erythrocyte volume, preoperative hemoglobin level, operation mode, operation time, anesthesia time, American Association of Anesthesiologists (ANA) (ASA) score, cardiac function grading (NYHA), intraoperative blood loss, intraoperative blood transfusion, intraoperative fentanyl, propofol and Dizocine dosage, postoperative white blood cell count, postoperative erythrocyte volume, postoperative hemoglobin level, Postoperative electrolytes (sodium, potassium) and univariate logistic regression analysis were used to analyze the risk factors. The independent risk factors were further investigated by multivariate Logistic regression analysis. Results Among 436 cases, 112 elderly patients had postoperative delirium, the incidence of delirium was about 25.68. The age, preoperative leukocyte count, erythrocyte specific volume, postoperative hemoglobin level in delirium group and non-delirium group were measured. There were significant differences in postoperative sodium concentration, anesthesia time, ASA score, cardiac function grading, blood loss during operation, postoperative use of Dizocine, history of diabetes, history of coronary heart disease and history of COPD (P < 0. 05). Multivariate logistic regression analysis showed that age, ASA score, postoperative Dizocine volume, and COPD history were independent risk factors for the occurrence of delirium after spinal surgery in elderly patients. Conclusion The elderly patients over 72 years old, the ASA score > 2, the use of Dizocine analgesic and the patients with COPD are the independent risk factors of postoperative delirium. |
KEY WORDS Spinal surgery Delirium Risk factors Elderly |
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