摘要
目的 通过回顾性研究探讨帕金森病(PD)患者术前基线认知功能和脑深部电刺激术(DBS)术后谵妄(POD)的关系.方法 回顾性收集患者术前基线资料及PD相关症状量表评分[包括非运动症状量表(NMSS)评分、运动障碍协会-统一帕金森病评定量表(MDS-UPDRS)评分、KINGS帕金森病疼痛量表(KPPS)评分、汉密尔顿抑郁量表(HAMD)评分和汉密尔顿焦虑量表(HAMA)评分].术前及术后24、72h采用简易精神状态检查量表(MMSE)评分对患者进行认知功能评估.术后3d内采用意识模糊评估法(CAM)对患者进行谵妄评估,根据是否出现POD将患者分为POD组和非POD组.采用二元logistic回归分析术前认知功能和POD的关系.结果 共纳入226例患者,其中37例(16.37％)患者发生POD.与非POD组比较,POD组患者年龄更大,糖尿病发生率更高,手术时间更长,术前及术后24、72 h MMSE评分更低,NMSS评分更高,MDS-UPDRS第一部分、第二部分、第三部分评分更高(均P＜0.05).两组患者女性例数、体重指数(BMI)、美国麻醉医师协会(ASA)分级、受教育水平、高血压发生率、冠心病发生率、NMSS评分、KPPS评分、HAMD评分、HAMA评分及MDS-UPDRS第四部分评分比较,差异无统计学意义(均P＞0.05).多因素logistic回归分析表明,术前MMSE评分[比值比(OR)0.83,95％置信区间(CI)0.75～0.93,P=0.001]、年龄(OR 1.16,95％CI 1.08～1.26,P＜0.001)、糖尿病(OR 3.79,95％CI 1.12～12.81,P=0.032)和 POD 独立相关.结论 较低的术前MMSE评分、高龄和糖尿病是PD患者DBS后POD的独立危险因素.
Abstract
Objective To retrospectively investigate the relationship between preoperative baseline cognitive function and postoperative delirium(POD)in Parkinson's disease(PD)patients undergoing deep brain stimulation(DBS)surgery.Methods Pre-operative baseline data and PD-related symptom scale scores,including the Non-Motor Symptom Scale(NMSS)score,the Movement Disorder Society-Unified Parkinson's Disease Rating Scale(MDS-UPDRS)score,the KINGS Parkinson's Disease Pain Scale(KPPS)score,Hamilton Depression Scale(HAMD)score and Hamilton Anxiety Scale(HAMA)score were collected for retrospective analysis.The cognitive function of the patients was assessed by the Mini-Mental State Examination(MMSE)score before surgery and 24,72 h af-ter surgery.Delirium was assessed by the Confusion Assessment Method(CAM)within 3 days after surgery.According to the presence of delirium after surgery,the patients were divided into two groups:a POD group and a non-POD group.The relationship between preop-erative cognitive function and POD was analyzed through binary logistic regression analysis.Results A total of 226 patients were in-cluded,where 37 patients(16.37％)presented POD.Compared with the non-POD group,patients in the POD group showed increases in age,the incidence of diabetes,the operative time,as well as reduced MMSE scores before and 24 h and 72 h after surgery,increased NMSS scores,and increased scores in MDS-UPDRS part Ⅰ,Part Ⅱ and Part Ⅲ(all P＜0.05).There were no statistical differences in the number of female patients,body mass index(BMI),American Society of Anesthesiologists(ASA)grade,education level,the inci-dences of hypertension and coronary heart disease,NMSS score,KPPS score,HAMD score,HAMA score and MDS-UPDRS Part Ⅳscore between the two groups(all P＞0.05).Multivariate logistic regression analysis showed that preoperative MMSE score[odds ratio(OR)0.83(95％confidence interval(CI)0.75,0.93),P=0.001],age[OR 1.16(95％CI 1.08,1.26),P＜0.001]and diabetes[OR 3.79(95％CI 1.12,12.81),P=0.032]were independently associated with POD.Conclusion Lower preoperative MMSE score,advanced age and diabetes are the independent risk factors for POD after DBS surgery in PD patients.
基金项目
国家自然科学基金(81871579)
国家自然科学基金(82272205)
海军军医大学第一附属医院临床科学创新项目(2020YXK013)
NETL
NSTL
万方数据