文章摘要
多病共存亚型对非心脏手术老年患者术后谵妄的影响：一项潜在类别分析
Effect of multimorbidity subtypes on postoperative delirium in elderly non-cardiac surgery patients: a latent class analysis
  
DOI：10.12089/jca.2025.12.009
中文关键词: 非心脏手术  老年  多病共存  亚型  术后谵妄
英文关键词: Non-cardiac surgery  Aged  Multimorbidity  Subtype  Postoperative delirium
基金项目:
作者单位E-mail
高戎 210014,南京市中西医结合医院重症医学科  
段华玮 南京医科大学第二附属医院麻醉科  
万幸 南京医科大学第二附属医院麻醉科 3278671@qq.com 
摘要点击次数: 899
全文下载次数: 287
中文摘要:
      
目的：确定老年非心脏手术患者的多种共病是否存在独特的潜在亚型，并明确不同亚型的特征对术后谵妄（POD）风险的影响。
方法：选择非心脏手术老年患者700例，男432例，女268例，年龄≥65岁，BMI 18.5～38.0 kg/m2，ASA Ⅰ—Ⅳ级。基于国际疾病分类第10版诊断的疾病组成与赤池信息最小化原则，采用潜在类别分析（LCA）确定患者多病共存亚型。采用中介作用分析多病共存亚型、术前埃德蒙顿衰弱量表（EFS）评分对POD的影响。
结果：共有124例（17.7%）患者发生POD。本研究确定了3个多病共存亚型，依据确定的亚型中疾病发生率最高的疾病进行亚型的命名，分为心血管疾病亚型、内分泌代谢疾病亚型和不良生活习惯亚型。与内分泌代谢疾病亚型比较，心血管疾病亚型和不良生活习惯亚型EFS评分和POD发生率明显偏低，术前简易精神状态检查量表（MMSE）评分明显偏高（P<0.05）。内分泌代谢疾病亚型、年龄偏大、术前EFS评分偏高和术前MMSE评分偏低是POD的独立危险因素。内分泌代谢疾病亚型通过衰弱对POD的间接效应值为0.049（95%CI 0.033～0.069）。在校正年龄和术前MMSE评分后，间接效应值为0.016（95%CI 0.004～0.029）。内分泌代谢疾病亚型通过衰弱对术前MMSE评分的间接效应值为-1.854（95%CI -2.447～-1.368）。在校正年龄后，间接效应值为-1.323（95%CI -1.828～-0.891）。
结论：内分泌代谢疾病亚型显著增加非心脏手术老年患者POD发生率。在内分泌代谢疾病亚型中，衰弱通过中介作用显著增加了POD的发生风险。
英文摘要:
      
Objective: To determine whether unique latent subtypes of multimorbidity exist in elderly patients undergoing non-cardiac surgery and to clarify the effect of different subtype characteristics on the risk of postoperative delirium (POD).
Methods: A total of 700 elderly patients scheduled for non-cardiac surgery were selected, 432 males and 268 females, aged ≥ 65 years, BMI 18.5-38.0 kg/m2, ASA physical status Ⅰ-Ⅳ. Latent class analysis (LCA), based on disease composition diagnosed according to the international classification of diseases (tenth revision), and the Akaike information criterion minimization principle was used to identify multimorbidity subtypes. Mediation analysis was employed to explore the effects of multimorbidity subtypes and Edmonton frail scale (EFS) scores on POD.
Results: A total of 124 patients (17.7%) developed POD. Three distinct multimorbidity subtypes were identified and named based on the disease with the highest prevalence within each subtype: the cardiovascular disease subtype, the endocrine-metabolic disease subtype, and the adverse health habits subtype. Compared with the endocrine-metabolic disease subtype, the cardiovascular disease and adverse health habits subtypes showed significantly lower preoperative EFS scores and POD incidence, and significantly higher preoperative mini-mental state examination (MMSE) scores (P < 0.05). The endocrine-metabolic disease subtype, advanced age, high preoperative EFS score, and low preoperative MMSE score were identified as independent risk factors of POD. The endocrine-metabolic disease subtype exerted an indirect effect on POD through frailty, with an effect value of 0.049 (95% CI 0.033 to 0.069). The indirect effect remained significant at 0.016 (95% CI 0.004 to 0.029) after adjusting for age and preoperative MMSE score. The indirect effect of the endocrine-metabolic disease subtype on preoperative MMSE score through frailty was -1.854 (95% CI -2.447 to -1.368). The indirect effect was -1.323 (95% CI -1.828 to -0.891) after adjusting for age.
Conclusion: The endocrine-metabolic disease subtype significantly increases the incidence of POD in elderly patients undergoing non-cardiac surgery. Within this subtype, frailty significantly contributes to the increased risk of POD through its mediating effect.
查看全文   查看/发表评论  下载PDF阅读器
关闭