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| 内镜逆行胰胆管造影术中平均动脉压波动轨迹与术后谵妄的相关性 |
| Correlation between trajectory of mean arterial pressure fluctuations and postoperative delirium during endoscopic retrograde cholangiopancreatography |
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| DOI：10.12089/jca.2025.05.006 |
| 中文关键词: 内镜逆行胰胆管造影 术后谵妄 平均动脉压 轨迹模型 |
| 英文关键词: Endoscopic retrograde cholangiopancreatography Postoperative delirium Mean arterial pressure Trajectory model |
| 基金项目:兰州大学第一医院院内基金（ldyyyn2023-95） |
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| 摘要点击次数: 374 |
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| 中文摘要: |
目的：构建内镜逆行胰胆管造影（ERCP）术中平均动脉压（MAP）波动轨迹模型，分析不同MAP波动轨迹与术后谵妄（POD）的相关性。
方法：选择2022年6月至2024年2月接受全身麻醉下ERCP的患者306例，男163例，女143例，年龄18～90岁，BMI＜30 kg/m2，ASAⅠ—Ⅲ级。通过基于群体的轨迹模型（GBTM）识别并构建ERCP术中MAP波动轨迹，根据贝叶斯信息准则（BIC）、人群比例等评价指标选择最佳亚组数的MAP波动轨迹，比较不同亚组的MAP波动轨迹在基线特征、围术期不良事件及POD的差异。采用Logistic回归分析不同MAP波动轨迹与POD的相关性。
结果：通过GBTM分析，将306例行ERCP的患者分为三个不同MAP波动轨迹亚组：MAP呈低水平稳定组（L组，n=71）、MAP呈中等水平稳定组（M组，n=157）和MAP呈高水平波动组（H组，n=78）。L组2例（2.8%）、M组3例（1.9%）、H组8例（10.3%）发生POD。与H组比较，M组POD发生率明显降低，MAP方差明显降低，手术时间明显延长（P<0.05），L组MAP方差明显降低，舒芬太尼及右美托咪定用量明显减少，睫毛反应消失时间明显缩短（P<0.05）。与M组比较，L组舒芬太尼用量明显减少（P<0.05）。Logistic回归结果显示，以L组作为参照，H组POD发生风险更高，在调整年龄、BMI、ASA分级、Mallampati分级、高血压史构建的模型2中，H组POD发生风险较高，OR=10.08（95%CI 1.11~91.67）（P=0.040）；在模型2的基础上调整术前禁食时间、手术时间、睫毛反应消失时间、苏醒时间、使用镇静药物、发生呼吸抑制、发生低氧血症构建的模型3中，H组POD发生风险较高，OR=13.60（95%CI 1.02~181.20）（P=0.048）；趋势性检验显示，三个轨迹与POD的发生呈显著的线性趋势，H组POD发生风险最高（P＜0.05）。
结论：ERCP术中MAP波动轨迹与POD显著相关，术中MAP波动较大的轨迹提示POD发生风险更高。基于MAP的波动轨迹模型有助于识别POD高风险人群。 |
| 英文摘要: |
Objective: To construct trajectory models of mean arterial pressure (MAP) fluctuations during endoscopic retrograde cholangiopancreatography(ERCP), and analyze the correlation between different MAP fluctuation trajectories and postoperative delirium (POD).
Methods: A total of 306 patients, 163 males and 143 females, aged 18-90 years, BMI < 30 kg/m2, ASA physical status Ⅰ-Ⅲ, who underwent ERCP under general anesthesia from June 2022 to February 2024 were enrolled. Trajectories of intraoperative MAP fluctuations in ERCP were identified and constructed by group-based trajectory modelling (GBTM). The trajectories with the optimal number of subgroups were selected based on Bayesian information criterion (BIC), population proportion, and other evaluation indexes. Then baseline characteristics, perioperative adverse events, and POD were compared between trajectories of different subgroups. The correlation between different MAP fluctuation trajectories and POD were analyzed using Logistic regression.
Results: A total of 306 patients who underwent ERCP were divided into three groups of different MAP fluctuation trajectories by GBTM: a group with low-level stable MAP (group L, n = 71), a group with medium-level stable MAP (group M, n = 157), and a group with high-level fluctant MAP (group H, n = 78). There were 2 patients (2.8%) occurred POD in group L, 3 patients (1.9%) occurred POD in group M, and 8 patients (10.3%) occurred POD in group H. Compared with group H, group M had a significantly lower incidence of POD, significantly lower MAP variance, and a significantly longer operation time (P < 0.05), group L had a significantly lower MAP variance, a significantly lower dosage of sufentanil and dexmedetomidine, and a significantly shorter eyelash reflex disappearance time (P < 0.05). Compared with group M, the dosage of sufentanil was significantly lower in group L (P < 0.05). Taking group L as a reference, Logistic regression showed that patients in group H exhibited a higher risk of POD, adjusted for age, BMI, ASA physical status, Mallampati grades, history of hypertension in model 2, the group H had a higher risk of POD occurrence (OR = 10.08, 95% CI 1.11-91.67, P = 0.040). On the basis of model 2, model 3 was adjusted for preoperative fasting time, surgical time, disappearance time of eyelash reaction, awakening time, use of sedatives, occurrence of respiratory depression, and occurrence of hypoxemia, the group H had a higher risk of POD occurrence (OR = 13.60, 95% CI 1.02-181.20, P = 0.048). The trend test showed a significant linear trend between the three trajectories and the occurrence of POD, with group H having the highest risk of POD (P < 0.05).
Conclusion: The trajectories of intraoperative MAP fluctuation during ERCP were significantly correlated with POD, and the trajectories with greater intraoperative MAP fluctuation suggested a higher risk of POD. |
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