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| 脊柱手术患者术后谵妄的危险因素分析 |
| Risk factors of postoperative delirium in patients undergoing spinal surgery |
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| DOI：10.12089/jca.2022.09.005 |
| 中文关键词: 脊柱手术 术后谵妄 危险因素 回归分析 |
| 英文关键词: Spinal surgery Postoperative delirium Risk factors Regression analysis |
| 基金项目:嘉兴市科技计划项目（2017BY18044,2020AD30136） |
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| 中文摘要: |
目的 探讨脊柱手术患者术后谵妄（POD）的危险因素，并建立脊柱手术患者POD的风险预测模型。
方法 回顾性收集行脊柱手术患者1 075例，男570例，女505例，年龄≥18岁，BMI 18～35 kg/m2，ASA Ⅰ—Ⅲ级。采用意识模糊评估法-中文修订版（CAM-CR）量表进行评估，根据是否发生POD将患者分为两组：POD组和非POD组。采用单因素分析筛选POD的相关因素，将P＜0.1的相关因素纳入二元Logistic回归模型，分析脊柱手术患者POD的独立危险因素并建立预测模型。绘制受试者工作特征（ROC）曲线并计算ROC曲线下面积（AUC）评价预测模型的价值。
结果 有84例（7.81%）患者发生POD。与非POD组比较，POD组年龄明显增大（P＜0.05），ASA分级＞Ⅱ级、METs＜4比例明显升高（P＜0.05），手术侵入类型级别明显升高（P＜0.05），BIS监测比例明显降低（P＜0.05），竖脊肌平面阻滞联合全凭静脉麻醉比例明显降低、静-吸复合麻醉和全凭静脉麻醉比例明显升高、出血量明显增加、术后Hb及术后钠离子浓度明显降低、术后第1天VAS疼痛评分明显升高（P＜0.05）。二元Logistic回归分析结果显示，年龄＞60岁（OR=1.099，95%CI 1.062～1.136）、酗酒史（OR=3.427，95%CI 1.859～6.315）、4级手术（OR=25.542，95%CI 1.878～347.342）、出血量＞431 ml（OR=1.005，95%CI 1.002～1.007）、术后第1天VAS疼痛评分＞2分（OR=1.797，95%CI 1.389～2.325）是脊柱手术患者POD的危险因素，BIS监测（OR=0.310，95%CI 0.144～0.669）、竖脊肌平面阻滞联合全凭静脉麻醉（OR=0.138，95%CI 0.051～0.373）、术后Hb＞122.8 g/L（OR=0.966，95%CI 0.943～0.993）是脊柱手术患者POD的保护因素。预测模型为Logit（P）=0.094×年龄+1.232×酗酒史-0.035×术后Hb+3.240×4级手术-1.171×BIS监测-1.980×竖脊肌平面阻滞联合全凭静脉麻醉+0.005×出血量+0.586×术后第1天VAS疼痛评分-9.648，该模型AUC为0.933（95%CI 0.917～0.948，P<0.001），敏感性为90.5%，特异性为82.1%。
结论 年龄＞60岁、酗酒史、手术侵入类型（4级手术）、出血量＞431 ml以及术后第1天VAS疼痛评分＞2分是脊柱手术患者POD的独立危险因素。 |
| 英文摘要: |
Objective To investigate the risk factors of postoperative delirium (POD) to establish a risk prediction model for POD in patients undergoing spinal surgery.
Methods A total of 1 075 patients undergoing spinal surgery were retrospectively collected, including 570 males and 505 females, aged ≥18 years, BMI 18-35 kg/m2, ASA physical status Ⅰ-Ⅲ. Patients were evaluated using the Confusion Assessment Method-Chinese Revision (CAM-CR) scale, and were divided into two groups according to whether they had POD: the POD group and the non-POD group. Univariate analysis was used to screen the related factors of POD. The correlated with P < 0.1 were included in a binary Logistic regression model to analyze independent risk factors for POD in patients undergoing spinal surgery and to develop a prediction model. The receiver operating characteristic (ROC) curve was drawn and calculate the area under the curve (AUC) was calculated to evaluate the value of predictive models.
Results POD occurred in 84 (7.81%) patients. Compared with the non-POD group, the age was significantly increased in POD group (P < 0.05), the proportion of ASA physical status > Ⅱ and METs < 4 were significantly increased (P < 0.05), the level of surgical invasiveness and the proportion of BIS monitoring were significantly increased (P < 0.05); the proportion of erector spinae block combined with total intravenous anesthesia decreased significantly, while the proportion of static-aspiration combined anesthesia and total intravenous anesthesia increased significantly, the amount of bleeding were significantly increased, postoperative Hb and postoperative sodium ion were significantly decreased, and VAS pain score was significantly increased on the first day after operation (P < 0.05). Binary Logistic regression analysis showed that age > 60 years (OR=1.099, 95% CI 1.062 to 1.136), history of alcohol abuse (OR = 3.427, 95% CI 1.859 to 6.315), grade 4 surgery (OR = 25.542, 95% CI 1.878 to 347.342), bleeding > 431 ml (OR = 1.005, 95% CI 1.002 to 1.007), and VAS pain score > 2 on the first postoperative day (OR = 1.797, 95% CI 1.389 to 2.325) were risk factors for POD in patients undergoing spinal surgery; BIS monitoring (OR = 0.310, 95% CI 0.144 to 0.669), vertical spinal muscle block combined with total intravenous anesthesia(OR = 0.138, 95% CI 0.051 to 0.373), postoperative Hb > 122.8 g/L (OR = 0.966, 95% CI 0.943 to 0.993) were protective factors for POD in patients undergoing spinal surgery. The predictive model was constructed as Logit(P) = 0.094 × age + 1.232 × history of alcohol abuse - 0.035 × postoperative Hb + 3.240 × 4-stage surgery - 1.171 × BIS monitoring - 1.980 × vertical spinal muscle block combined with total intravenous anesthesia + 0.005 × bleeding + 0.586 × VAS pain score on the first postoperative day - 9.648, and the AUC of this model was 0.933 (95% CI 0.917 to 0.948, P < 0.001), sensitivity was 90.5%, specificity was 82.1%.
Conclusion Age > 60 years, history of alcohol abuse, type of surgical invasion (4-stage surgery), bleeding > 431 ml, and VAS pain score > 2 on the first postoperative day are independent risk factors for POD in patients undergoing spine surgery. |
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