目的:探讨老年脊柱手术患者术后谵妄的危险因素。
方法:回顾性分析2021年1月至2023年1月566例全麻脊柱手术患者的基本病例资料。男性296例,女性270例,平均年龄(71.58±4.21)岁。颈椎手术195例,胸椎手术26例,腰椎手术345例。根据术后谵妄的发生情况,将患者分为术后谵妄组(41例)和无谵妄组(525例)。采用单因素分析,对性别、年龄,体重,吸烟史,饮酒史,手术部位,术前焦虑,术中低血压次数,失血等等,采用二元Logistic回归分析单因素,P<0.05。
结果:共有41例患者出现术后谵妄。单因素分析显示年龄(P=0.000),手术时间(P=0.039),术前焦虑(P=0.001),失血量(P=0.000),阿片类药物使用史(P=0.003),卒中病史(P=0.005),C反应蛋白(P=0.000),谵妄组和非谵妄组钠离子差异有统计学意义(P=0.000)。这些因素包括在二元Logistic回归分析中,结果显示年龄[OR=0.729,95CI(0.569,0.932),P=0.012],阿片类药物使用[OR=21.500,95CI(1.334,346.508),P=0.031],失血量[OR=0.932,95CI(0.875,0.993),P=0.029],C反应蛋白[OR=0.657,95CI(0.485,0.890),P=0.007],术前焦虑[OR=23.143,95CI(1.859,288.090),P=0.015],和钠[OR=1.228,95CI(1.032,1.461),P=0.020]是老年患者脊柱手术后谵妄发生的独立危险因素。
结论:年龄,阿片类药物的使用,失血,术前焦虑,C反应蛋白升高,低钠血症是老年脊柱手术患者术后谵妄发生的独立危险因素。
OBJECTIVE: To investigate the risk factors of postoperative delirium in elderly patients undergoing spine surgery.
METHODS: The basic case data of 566 patients who underwent spine surgery under general anesthesia from January 2021 to January 2023 were retrospectively analyzed. There were 296 males and 270 females with an average age of (71.58 ± 4.21) years old. There were 195 cases of cervical spine surgery, 26 cases of thoracic spine surgery and 345 cases of lumbar spine surgery.According to the occurrence of postoperative delirium, the patients were divided into postoperative delirium group(41 patients) and non-delirium group (525 patients). Univariate analysis was used to analyze the possible influencing factors such as gender, age, weight, smoking history, drinking history, surgical site, preoperative anxiety, intraoperative hypotension times, blood loss and so on, and binary Logistic regression was used to analyze the univariate factors with P<0.05.
RESULTS: A total of 41 patients developed postoperative delirium. Univariate analysis showed that age (P=0.000), duration of surgery (P=0.039), preoperative anxiety (P=0.001), blood loss (P=0.000), history of opioid use (P=0.003), history of stroke (P=0.005), C-reactive protein (P=0.000), sodium ion(P=0.000) were significantly different between delirium group and non-delirium group. These factors were included in the binary Logistic regression analysis, and the results showed that age [OR=0.729, 95%CI(0.569, 0.932), P=0.012], opioid use [OR=21.500, 95%CI(1.334, 346.508), P=0.031], blood loss [OR=0.932, 95%CI(0.875, 0.993), P=0.029], C-reactive protein [OR=0.657, 95%CI(0.485, 0.890), P=0.007], preoperative anxiety [OR=23.143, 95%CI(1.859, 288.090), P=0.015], and sodium [OR=1.228, 95%CI(1.032, 1.461), P=0.020] were independent risk factors for the development of delirium after spinal surgery in elderly patients.
CONCLUSIONS: Age, opioid use, blood loss, preoperative anxiety, elevated c-reactive protein, and hyponatremia are independent risk factors for the development of postoperative delirium in elderly patients undergoing spinal surgery.