目的:探讨老年患者脊柱手术后谵妄的危险因素。方法:回顾性分析自2021年1月至2023年1月在全麻下行脊柱手术566例患者的基本病例资料，其中男296例，女270例;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。根据术后是否出现谵妄分为术后谵妄组41例与无谵妄组525例。对患者的性别、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、失血量等可能影响因素进行单因素分析，并对P＜0。05的单因素采用二元Logistic回归进行多因素分析。结果:术后谵妄者41例，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)、脑卒中病史(P=0。005)、术后C反应蛋白(P=0。000)、术后钠离子(P=0。000)在谵妄组与非谵妄组间差异有统计学意义。将上述因素纳入二元Logistic回归分析，结果显示:年龄[OR=0。729，95％CI(0。569，0。932)，P=0。012]、阿片类药物使用[OR=21。500，95％CI(1。334，346。508)，P=0。031]、失血量[OR=0。932，95％CI(0。875，0。993)，P=0。029]、术后 C 反应蛋白[OR=0。657，95％CI(0。485，0。890)，P=0。007]、术前焦虑[OR=23。143，95％CI(1。859，288。090)，P=0。015]、术后钠离子[OR=1。228，95％CI(1。032，1。461)，P=0。020]是老年患者脊柱手术术后发生谵妄的独立危险因素。结论:年龄、阿片类药物使用、失血量、术前焦虑、C反应蛋白升高、低钠血症是老年患者脊柱手术术后谵妄发生的独立危险因素。
Analysis of risk factors for postoperative delirium in elderly patients undergoing spinal surgery
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 Jan-uary 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 gen-der,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 pa-tients developed postoperative delirium.Univariate analysis showed that age(P=0.000),duration of surgery(P=0.039),preop-erative 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.Conclusion Age,opioid use,blood loss,preoper-ative anxiety,elevated c-reactive protein,and hyponatremia are independent risk factors for the development of postoperative delirium in elderly patients undergoing spinal surgery.
万方数据
维普
