|
| 术前指尖触觉功能预测老年患者髋部手术后谵妄的价值 |
| Predictive value of preoperative fingertip tactile function for postoperative delirium in elderly patients urdergoing hip surgery |
| |
| DOI：10.12089/jca.2025.05.007 |
| 中文关键词: 触觉功能 老年 髋部骨折 术后谵妄 |
| 英文关键词: Tactile function Aged Hip fracture Postoperative delirium |
| 基金项目:安徽省高校科学研究重点项目（2022AH052338）；安徽省高校自然科学研究项目（2023AH053373） |
|
| 摘要点击次数: 304 |
| 全文下载次数: 95 |
| 中文摘要: |
目的：分析术前指尖触觉功能与老年患者髋部手术发生术后谵妄（POD）的相关性，评价术前指尖触觉功能改变预测POD的临床价值。
方法：选择2024年3—10月择期行全麻下髋部骨折手术的老年患者120例，男32例，女88例，年龄≥65岁，BMI 18.5～26.0 kg/m2，ASA Ⅱ或Ⅲ级。术前1 d采用简易智力状态检查量表（MMSE）评定认知状态，采用标准化触觉检测套件测定指尖触觉阈值并进行分级。术后1—3 d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内是否发生POD将患者分为两组：POD组（n=24）和非POD组（n=96）。采用多因素Logistic回归分析术前1 d指尖触觉阈值分级与POD发生的相关性，绘制受试者工作特征（ROC）曲线评估术前1 d指尖触觉阈值分级对POD的预测效能。
结果：与非POD组比较，POD组年龄明显增大，术前1 d MMSE评分明显降低，术前1 d指尖触觉阈值分级明显升高（P＜0.05）。多因素Logistic回归分析结果显示，年龄、术前1 d MMSE评分和术前1 d指尖触觉阈值分级均为POD的独立危险因素，且术前1 d指尖触觉阈值分级每升高1级，POD发生风险随之升高（OR=3.785，95%CI 1.847～7.753，P＜0.001）。术前1 d指尖触觉阈值分级预测POD的ROC曲线下面积（AUC）为0.798，最佳诊断临界值为3.5级，敏感性为79.2%，特异性为66.7%。年龄、术前1 d MMSE评分与术前1 d指尖触觉阈值分级对POD的共同预测效能更高（AUC=0.942，95%CI 0.902～0.983），敏感性为95.8%，特异性为82.3%。
结论：术前1 d指尖触觉阈值升高是老年患者髋部手术后发生POD的独立危险因素，术前1 d指尖触觉阈值分级＞3.5级对POD具有一定的预测价值。 |
| 英文摘要: |
Objective: To investigate the correlation between preoperative fingertip tactile function and postoperative delirium (POD) in the elderly patients undergoing hip surgery, and to evaluate the predictive value of preoperative changes in fingertip tactile function for POD.
Methods: A total of 120 elderly patients from March 2024 to Octomber 2024, 32 males and 88 females, aged ≥ 65 years, BMI 18.5-26.0 kg/m2, ASA physical status Ⅱ or Ⅲ, who underwent elective general anesthesia hip fracture surgery were selected. The cognitive status was assessed by the mini-mental state examination (MMSE) 1 day before surgery, and the fingertip tactile threshold was measured and graded by the standardized tactile detection kit. The occurrence of POD was assessed using the confusion assessment method (CAM) 1 to 3 days after surgery. The patients were divided into two groups according to whether POD occurred within 3 days after surgery: the POD group (n = 24) and the non-POD group (n = 96). Multifactorial Logistic regression analysis was used to clarify the correlation between fingertip tactile threshold grades and the occurrence of POD, and the predictive efficacy of fingertip tactile threshold grades for POD was explored by plotting the receiver operating characteristic (ROC) curve.
Results: Compared with the non-POD group, patients in the POD group were significantly older, the preoperative MMSE score 1 day before the surgery was significantly lower, and the preoperative fingertip tactile threshold grading was significantly higher (P < 0.05). The results of multifactorial logistic regression analysis showed that age, preoperative MMSE score, and fingertip tactile threshold grades1 day before the surgery were independent risk factors for POD in elderly patients with hip fractures, and the risk of POD increased with every 1 grade increase in tactile threshold grading (OR = 3.785, 95% CI 1.847-7.753, P < 0.001). The fingertip tactile threshold grades 1 day before the surgery predicted POD with an area under the ROC curve (AUC) of 0.798, an optimum threshold of 3.5 grades, a sensitivity of 79.2%, and a specificity of 66.7%. The co-predictive efficacy of age, MMSE score 1 day before the surgery, and tactile threshold grades 1 day before the surgery for POD was higher (AUC = 0.942, 95% CI 0.902-0.983), with a sensitivity of 95.8% and a specificity of 82.3%.
Conclusion: Fingertip tactile hypofunction 1 day before the surgery is identified as an independent risk factor for the development of POD in elderly patients undergoing general anesthesia for hip surgery, and a fingertip tactile threshold grades > 3.5 grades may have some predictive value for POD. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
