老年患者脊柱手术后谵妄的危险因素分析

Risk factors of delirium in elderly patients after spinal operation

摘要:

目的：探讨老年患者脊柱手术后谵妄的发病率及相关危险因素。方法：2011年1月至2012年12月随机选取200例老年脊柱手术病人进行研究，分别对性别、年龄、麻醉方式、手术部位（颈椎、胸椎、腰椎）、手术时间、复苏时间、术前心理状态、术后睡眠情况、是否合并基础疾病（高血压、冠心病、糖尿病、高脂血症、慢支炎）、出血量、术中血压情况等因素进行统计，logistic回归分析相关因素对老年患者脊柱手术后谵妄发生的影响。结果：老年患者脊柱手术后谵妄总发生率为11%（22/200）；logistic回归分析显示：老年患者脊柱手术后谵妄与性别、术中出血量和是否合并基础疾病等因素无明确关系（P ＞0.05）；而与年龄、麻醉方式、手术部位、手术持续时间、术后复苏时间、术中低血压、术前心理状态和术后睡眠障碍等因素关系密切（P＜0.05），OR值及其95%CI分别为7.107（0.238 1~1.211 6）、12.613（0.869 5~6.086 2）、6.978（-5.865 9~-1.131 7）、3.697 （0.194 8~6.070 5）、5.367（1.014 1~7.701 0）、3.012（0.067 7~5.517 9）、6.078（1.130 4~6.555 2）、3.018（-6.798 9~-0.668 05）。结论：老年患者脊柱手术后谵妄发病率较高，高龄、全麻、长时间手术或复苏、术中低血压、术前心理状态不稳和术后睡眠障碍是其主要危险因素。

Abstract:

Objective：To investigate the morbidity rate and risk factors of delirium after spinal operation in elderly patients. Methods： From January 2011 to December 2012，200 elderly patients after spinal operation were randomly selected. The following factors：pa－tients’ gender，age，anesthesia method，surgical site（cervical vertebra，thoracic vertebra，lumbar vertebra），duration of surgery，postop－erative recovery time，preoperative psychological state，postoperative sleep，whether in complication of underlying diseases（hyperten－sion，coronary heart disease，diabetes，hyperlipidemia，chronic bronchitis），the amount of bleeding，intraoperative blood pressure，were carried on the risk assessment by means of statistical analysis to predict the responsibility rate for elderly spinal operation patients with postoperative delirium. Results：The morbidity rate of delirium after spinal operation in elderly patients was 11%（22/200）. Logis－tic regression analysis indicated that the morbidity rate of delirium after spinal operation was not clearly correlated with factors of pa－tients’ gender，the amount of bleeding and whether in complication with underlying diseases（P ＞0.05）. It was closely related with age，anesthesia method，surgical site，duration of surgery，postoperative recovery time，intraoperative blood pressure，preoperative psycholog－ical state and postoperative sleep（P＜0.05）；the value of OR and its 95%CI were 7.107（0.238 1 to 1.211 6），12.613（0.869 5 to 6.086 2），6.978（-5.865 9 to-1.131 7），3.697（0.1948 to 6.0705），5.367（1.014 1 to 7.701），3.012（0.067 7 to 5.517 9），6.078（1.130 4 to 6.555 2），3.018（-6.798 9 to -0.668 05）. Conclusion：The morbidity rate of delirium after spinal operation in elderly patients is considerablely high and the major risk factors are advanced in years，general anesthesia，duration of surgery or postoperative recovery time，hypoten－sion，unstable mental state in the preoperative and postoperative sleep disorders.