目的:本研究的主要目的是探讨内镜经蝶入路垂体腺瘤手术后患者谵妄发生率的相关因素。
方法:研究对象为2022年1-12月天津市环湖医院颅底内镜中心收治的患者,采用回顾性队列研究设计。使用4'A测试(4AT)量表评估围手术期谵妄的存在,谵妄的最终诊断由临床医生确定。统计分析包括倾向得分匹配(PSM),χ2检验,和二元Logistic回归。
结果:本研究共纳入213例患者,谵妄发生率为29.58%(63/213)。其中,126例患者使用PSM(谵妄:非谵妄=1:1),确保年龄,性别,病理匹配。根据对多个变量进行单变量分析的结果,二元逻辑回归表明有酗酒史(OR=6.89,[1.60-29.68],P=0.010),术前视神经压迫症状(OR=4.30,[1.46-12.65],P=0.008),运行时间≥3小时(OR=5.50,[2.01-15.06],P=0.001),用于镇静的苯二氮卓类药物(OR=3.94,[1.40-11.13],P=0.010),睡眠障碍(OR=3.86,[1.40-10.66],P=0.009),和身体约束(OR=4.53,[1.64-12.53],P=0.004)是垂体腺瘤术后谵妄的独立危险因素。
结论:对于有酒精中毒史并出现视神经压迫症状的垂体腺瘤患者,以及操作时间≥3小时,加强医疗保健提供者和患者之间的沟通,改善围手术期睡眠质量,减少身体约束可能有助于降低术后谵妄的发生率。
OBJECTIVE: The primary aim of this
study is to explore the factors associated with delirium incidence in postoperative patients who have undergone endoscopic transsphenoidal approach surgery for pituitary adenoma.
METHODS: The
study population included patients admitted to Tianjin Huanhu Hospital\'s Skull Base Endoscopy Center from January to December 2022, selected through a retrospective cohort
study design. The presence of perioperative delirium was evaluated using the 4 \'A\'s Test (4AT) scale, and the final diagnosis of delirium was determined by clinicians. Statistical analysis included Propensity Score Matching (PSM), χ2 Test, and Binary Logistic Regression.
RESULTS: A total of 213 patients were included in this
study, and the incidence of delirium was found to be 29.58 % (63/213). Among them, 126 patients were selected using PSM (delirium:non-delirium = 1:1), ensuring age, gender, and pathology were matched. According to the results of univariate analysis conducted on multiple variables, The binary logistic regression indicated that a history of alcoholism (OR = 6.89, [1.60-29.68], P = 0.010), preoperative optic nerve compression symptoms (OR = 4.30, [1.46-12.65], P = 0.008), operation time ≥3 h (OR = 5.50, [2.01-15.06], P = 0.001), benzodiazepines for sedation (OR = 3.94, [1.40-11.13], P = 0.010), sleep disorder (OR = 3.86, [1.40-10.66], P = 0.009), and physical restraint (OR = 4.53, [1.64-12.53], P = 0.004) as independent risk factors for postoperative delirium following pituitary adenoma surgery.
CONCLUSIONS: For pituitary adenoma patients with a history of alcoholism and presenting symptoms of optic nerve compression, as well as an operation time ≥3 h, enhancing communication between healthcare providers and patients, improving perioperative sleep quality, and reducing physical restraint may help decrease the incidence of postoperative delirium.