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| 听力减退与全麻腹部手术患者术后谵妄的相关性 |
| Correlation between hearing loss and postoperative delirium in patients undergoing general anesthesia abdominal surgery |
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| DOI：10.12089/jca.2020.06.003 |
| 中文关键词: 听力减退 术后谵妄 腹部手术 |
| 英文关键词: Hearing loss Postoperative delirium Abdominal surgery |
| 基金项目: |
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| 中文摘要: |
目的 探讨听力减退与全麻腹部手术患者术后谵妄（POD）的相关性，同时评价听力减退对POD的早期预测价值。
方法 本研究设计为单中心、前瞻性、观察性队列研究。选择2019年1—6月择期行全麻腹部手术患者119例，男80例，女39例，年龄65~86岁，BMI 14~32 kg／m2，ASA Ⅰ—Ⅲ级。术前1 d 采用纯音测听进行听阈测试。术后2 h及术后1~3 d每天2次（上午和下午各1次，2次间隔时间6 h）采用意识模糊评估量表（CAM）评估POD的发生情况。根据术后3 d内POD发生与否分为两组：谵妄组（POD组）和非谵妄组（NPOD组）。记录患者一般临床资料、手术麻醉相关资料、听阈测试结果和POD的发生情况。
结果 共29例（24.4%）患者发生POD。与NPOD组比较，POD组听阈明显升高（P<0.001）。多因素Logistic回归分析结果显示，听阈每增高1 dB，POD发生风险明显增高（OR=1.072，95%CI 1.022~1.124，P=0.004）。听阈预测POD的ROC曲线下面积为0.771，临界值为27 dB，敏感性为89.7%，特异性为57.8%（P＜0.001）。
结论 听力减退是全麻腹部手术患者POD发生的独立危险因素之一，听阈>27 dB对POD可能具有一定的预测价值。 |
| 英文摘要: |
Ojective To explore the correlation between hearing loss and postoperative delirium(POD) in patients undergoing general anesthesia abdominal surgery, and evaluate the value of hearing loss in early prediction of POD.
Methods This study was a single-center, prospective and observational cohort study. A total of 119 patients undergoing elective general anesthesia abdominal surgery, 80 males and 39 females, aged 65-86 years, with a BMI of 14-32 kg／m2, falling into ASA physical status Ⅰ-Ⅲ, were selected from January 2019 to June 2019. All patients were assessed by mini mental state examination (MMSE) before surgery, and tested by pure tone audiometry one day before surgery. POD was assessed 2 hours after surgery and twice daily in the first 3 postoperative days at 6 hours intervals, using the Confusion Assessment Method or Confusion Assessment Method for Intensive Care Unit (CAM). According to whether POD happened or not, the patients were divided into delirium group (group POD) and non-delirium group (group NPOD). General clinical data, operative anesthesia related data, the result of pure tone audiometry and occurrence of delirium were recorded.
Results POD occurred in 29 patients (24.4%). The hearing threshold was significantly higher in group POD than group NPOD (P < 0.001). Logistic regression analysis results showed that the risk of POD was significantly increased along with every 1 unit increase in hearing threshold (OR = 1.072， 95% CI 1.022-1.124， P = 0.004). The area under ROC curve predicted by hearing threshold for POD was 0.771, the critical value was 27 dB, the sensitivity was 89.7%, and the specificity was 57.8% (P < 0.001).
Conclusion The level of hearing threshold is one of the independent risk factors for POD in patients undergoing general anesthesia abdominal surgery. The hearing threshold > 27 dB may have a predictive effect on the occurrence of POD. |
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