目的 探讨老年结肠癌根治术患者发生术后谵妄(postoperative delirium,POD)的相关危险因素,为制定术后防治POD的应对措施提供依据.方法 纳入2018年1月至2021年12月期间在成都市新都区人民医院确诊为结肠癌并接受结肠癌根治术的128例老年患者作为研究对象.根据谵妄评估量表(4AT量表)评分对患者进行分组,收集2组患者的基本资料及围手术期主要临床数据和实验室指标,进行单因素和logistic回归分析,以确定潜在的老年结肠癌患者根治术后发生POD的危险因素.结果 根据4AT量表评分结果,以总分≥4分作为判定患者POD的阈值,128例患者中发生POD患者有29例(22.66％),未发生POD患者99例(77.34％).①一般资料比较:2组患者在性别、体质量指数、受教育年限、高血压、糖尿病、吸烟史和饮酒史方面比较差异无统计学意义(P＞0.05),在年龄、术前简易神经状态检查量表(mini-mental state examination,MMSE)评分和美国麻醉师协会(American Society of Anesthesiologists,ASA)分级方面比较差异有统计学意义(P＜0.05).②围手术期主要临床数据比较:2组患者在ICU治疗、非甾体抗炎药治疗、视觉模拟评分法评分和术中低血压方面比较差异无统计学意义(P＞0.05),而在手术时间、麻醉时间、术中失血量和右美托咪定治疗方面比较差异有统计学意义(P＜0.05).③术前实验室指标比较:2组患者在血红蛋白、血清白蛋白、白细胞计数、预后营养指数、中性粒细胞/淋巴细胞比值、D-二聚体和白蛋白与纤维蛋白原比率方面比较差异均无统计学意义(P＞0.05).④logistic回归分析结果显示,术前MMSE评分低[OR=0.397,95％CI为(0.234,0.673)]、手术时间长[OR=1.159,95％CI为(1.059,1.267)]和麻醉时间长[OR=1.138,95％CI为(1.057,1.226)]是老年结肠癌根治术患者POD发生的独立危险因素.结论 术前MMSE评分、手术时间和麻醉时间与老年结肠癌根治术后发生POD密切相关,值得临床实施围手术期重点管理,以预防和管理POD.
Analysis of related factors of postoperative delirium in elderly colon cancer patients undergoing radical surgery
Objective To explore the relevant risk factors for postoperative delirium(POD)in elderly patients undergoing radical colon cancer surgery,and provide a basis for formulating postoperative prevention and treatment measures for POD.Methods A total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People's Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects.Patients were divided into two groups according to the score of Delirium Assessment Scale(4AT Scale).The basic data,main perioperative clinical data and laboratory indicators of the two groups were collected,and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation.Results According to the results of the 4AT scale score,a total score of ≥4 points was used as the threshold for determining patient POD.Among 128 patients,there were 29 patients(22.66％)with POD and 99 patients(77.34％)without POD.① General data comparison:There was no significant difference between the two groups in gender,body mass index,years of education,hypertension,diabetes,smoking history and drinking history(P＞0.05),but there was significant difference in age,preoperative mini-mental state examination(MMSE)score and American Society of Anesthesiologists(ASA)grade(P＜0.05).② Comparison of main clinical data during the perioperative period:There was no statistically significant difference between the two groups of patients in ICU treatment,nonsteroidal anti-inflammatory drug treatment,visual analogue scale,and intraoperative hypotension(P＞0.05),but there was a statistically significant difference in operative time,anesthesia time,intraoperative blood loss,and dexmedetomidine treatment(P＜0.05).③ Comparison of preoperative laboratory indicators:There was no statistically significant difference between the two groups of patients in terms of hemoglobin,serum albumin,white blood cell count,prognostic nutritional index,neutrophil/lymphocyte ratio,D-dimer,and albumin to fibrinogen ratio(P＞0.05).④ The results of logistic regression analysis showed that low preoperative MMSE score[OR=0.397,95％CI(0.234,0.673)],long surgical time[OR=1.159,95％CI(1.059,1.267)],and long anesthesia time[OR=1.138,95％CI(1.057,1.226)]were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery.Conclusion Preoperative MMSE score,operative time,and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery,worth implementing key perioperative management in clinical practice to prevent and manage POD.
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