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| 老年患者膝关节置换术中血糖变异指数与术后谵妄的相关性 |
| Correlation between blood glucose variability index and postoperative delirium in elderly patients undergoing knee arthroplasty |
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| DOI：10.12089/jca.2024.10.009 |
| 中文关键词: 膝关节置换术 术后谵妄 血糖变异指数 危险因素 血糖 |
| 英文关键词: Knee arthroplasty Postoperative delirium Blood glucose variability index Risk factors Blood glucose |
| 基金项目:安徽省重点研究与开发计划项目（201904a07020026） |
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| 中文摘要: |
目的：探讨老年患者膝关节置换术中血糖变异指数（GLUCV）与术后谵妄（POD）的相关性。
方法：回顾性分析择期行膝关节置换术的老年患者112例，男16例，女96例，年龄65～80岁，BMI 22.0～28.0 kg/m2，ASA Ⅰ或Ⅱ级。根据术后5 d内是否发生POD将患者分为两组:POD组和非POD组。收集术前最后1次简易智力状态检查量表（MMSE）得分、手术时间、术中局部脑氧饱和度（rScO2）值降低幅度超过rScO2 基础值13%（ΔrScO2＞13%）的时间，术前血红蛋白（Hb）、C反应蛋白（CRP）浓度，入室前、麻醉诱导前、麻醉诱导后5 min、切皮后1 min、离室前采集指尖血糖浓度等资料，计算GLUCV。采用单因素和多因素Logistic回归分析老年膝关节置换术患者POD的危险因素，并计算比值比（OR）和95%可信区间（CI）。绘制受试者工作特征（ROC）曲线，通过计算曲线下面积（AUC）分析GLUCV的预测价值。
结果：术后5 d内发生POD 30例（26.8%）。与非POD组比较，POD组手术时间和术中ΔrScO2＞13%时间明显延长（P<0.05），CRP浓度、GLUCV明显升高（P<0.05）。多因素Logistic回归分析显示，术中ΔrScO2＞13%时间延长（OR=3.542，95%CI 1.380～9.093，P=0.011）、CRP浓度升高（OR=1.984，95%CI 1.078～3.650，P=0.015）、GLUCV升高（OR=5.257，95%CI 1.690～16.353，P=0.008）是老年膝关节置换术患者发生POD的危险因素。GLUCV预测老年膝关节置换术患者POD的AUC为0.747（95%CI 0.650～0.844，P<0.001），临界值为23.4%，敏感性为71.4%，特异性为63.3%。
结论：老年患者膝关节置换术GLUCV与POD存在明显相关性，同时GLUCV对于老年患者膝关节置换术发生POD具有良好的预测效能。 |
| 英文摘要: |
Objective: To investigate the correlation between blood glucose variability index (GLUCV) and postoperative delirium (POD) in elderly patients undergoing knee arthroplasty.
Methods: A total of 112 elderly patients undergoing elective knee arthroplasty were analyzed retrospectively, 16 males and 96 females, aged 65-80 years, BMI 22.0-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ. They were divided into two groups according to whether they had POD within 5 days after operation: POD group and non-POD group. The score of the last preoperative mini-mental state examination (MMSE), operation time, the duration of the intraoperative regional cerebral oxygen saturation (rScO2) value decreased by more than 13% of the rScO2 basic value (ΔrScO2> 13%), the preoperative hemoglobin (Hb) and C-reactive protein (CRP) concentration, the fingertip blood glucose concentration before entry, before anesthesia induction, 5 minutes after anesthesia induction, 1 minute after skin incision, and before leaving the chamber were collected, and the GLUCV was calculated. The risk factors of POD in elderly patients undergoing knee arthroplasty were analyzed by univariate and multivariate logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. The receiver operating characteristic (ROC) curve was drawn to calculate the area under the curve (AUC) and analyze the predictive value of GLUCV.
Results: Thirty patients (26.8%) showed POD symptoms within 5 days after surgery. Compared with the non-POD group, the operation time and duration of intraoperative ΔrScO2> 13% in the POD group were significantly prolonged (P < 0.05), the CRP concentration and GLUCV were significantly increased (P < 0.05). Multivariate logistic regression analysis showed that prolonged time of ΔrScO2> 13% (OR = 3.542, 95% CI 1.380-9.093, P = 0.011), elevated CRP concentration (OR = 1.984, 95% CI 1.078-3.650, P = 0.015), and elevated GLUCV(OR = 5.257, 95% CI 1.690-16.353, P = 0.008) were risk factors of POD in elderly patients undergoing knee arthroplasty. ROC curve analysis showed that the area under the AUC of GLUCV in predicting POD in elderly patients undergoing knee arthroplasty was 0.747 (95% CI 0.650-0.844, P < 0.001), while the optimal cutoff value was 23.4%, the sensitivity was 71.4%, and the specificity was 63.3%.
Conclusion: GLUCV is closely related to POD, and GLUCV level has a good predictive effect on POD in elderly patients undergoing knee arthroplasty. |
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