文章摘要
老年患者腹腔镜胃肠肿瘤手术前皮肤状态与术后谵妄的相关性
Association between the preoperative skin condition of elderly patients with gastrointestinal tumors undergoing laparoscopic surgery and postoperative delirium
  
DOI：10.12089/jca.2026.07.005
中文关键词: 腹腔镜  胃肠肿瘤手术  老年  皮肤状态  术后谵妄
英文关键词: Laparoscopy  Gastrointestinal tumor surgery  Aged  Skin condition  Postoperative delirium
基金项目:河北省医学科学研究课题计划(20240659)
作者单位E-mail
段然 050051,石家庄市,河北省人民医院麻醉科  
曹珑璐 050051,石家庄市,河北省人民医院麻醉科  
李攀 050051,石家庄市,河北省人民医院麻醉科  
吴晓倩 050051,石家庄市,河北省人民医院麻醉科  
李建立 050051,石家庄市,河北省人民医院麻醉科 hblijianli@163.com 
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中文摘要:
      
目的：探讨老年患者腹腔镜胃肠肿瘤术前皮肤状态与术后谵妄(POD)的相关性。
方法：选择择期行腹腔镜胃肠肿瘤手术的老年患者，年龄65～95岁，ASA Ⅱ或Ⅲ级。术前1 d采用皮肤衰老量表(SCINEXA)评估患者术前的皮肤状态。采用意识模糊评估法(CAM)评估术后7 d内POD的发生情况。根据术后7 d内是否发生POD将患者分为两组：POD组和非POD组(NPOD组)。采用多因素Logistic回归模型分析皮肤状态与POD的关系。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)及其95% 可信区间(CI)，评价SCINEXA评分预测POD的效能。Bootstrap法进行内部验证，敏感性分析验证结果稳健性。
结果：共纳入患者212例，有43例(20.3%)患者发生POD。年龄偏大、术前白蛋白偏低、术前血红蛋白偏低和SCINEXA评分偏高是POD的独立危险因素(P<0.05)。其中，SCINEXA 评分每增加1分，POD发生风险增加1.556倍(OR=2.556，95% CI 1.761～3.710，P<0.001)。SCINEXA评分预测腹腔镜胃肠道肿瘤手术老年患者POD的AUC为0.869(95％CI 0.816～0.922)，最佳截断值为 25.5 分，敏感性0.837，特异性0.740。基础模型预测POD的AUC为0.854(95%CI 0.780～0.928)，进一步纳入SCINEXA评分后，扩展模型AUC提高至0.929(95%CI 0.885～0.973)。Bootstrap内部验证提示模型稳定性良好。敏感性分析显示内在与外在衰老评分均与POD发生相关。
结论：老年患者腹腔镜胃肠肿瘤手术前皮肤状态与POD的发生存在明显相关性，术前皮肤状态衰老对POD存在一定的预测价值。
英文摘要:
      
Objective: To explore the association between the preoperative skin condition of elderly patients undergoing laparoscopic gastrointestinal tumor surgery and postoperative delirium (POD).
Methods: Elderly patients aged 65-95 years, with ASA physical status Ⅱ or Ⅲ, who were scheduled for elective laparoscopic gastrointestinal tumor surgery were selected. The preoperative skin condition of the patients was evaluated using the skin aging scale (SCINEXA) 1 day before the operation. The occurrence of POD within 7 days after surgery was assessed using the confusion assessment method (CAM). According to whether POD occurred within 7 days after surgery, patients were divided into two groups: POD group and non-POD (NPOD) group. A multivariate logistic regression model was used to analyze the relationship between the skin condition and POD. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) and its 95% confidence interval (CI) were calculated to evaluate the efficacy of the SCINEXA score in predicting POD. The Bootstrap method was used for internal validation, and sensitivity analysis was conducted to verify the robustness of the results.
Results: A total of 212 patients were included, and 43 patients (20.3%) developed POD. Older age, lower preoperative albumin level, lower preoperative hemoglobin level, and higher SCINEXA score were independent risk factors for POD (P < 0.05). Among them, for every 1-point increase in the SCINEXA score, the risk of POD occurrence increased by 1.556 times (OR = 2.556, 95% CI 1.761-3.710, P < 0.001). The ROC curve showed that the AUC of the SCINEXA score for predicting POD in elderly patients undergoing laparoscopic gastrointestinal tumor surgery was 0.869 (95% CI 0.816-0.922), with an optimal cut-off value of 25.5 points, a sensitivity of 0.837, and a specificity of 0.740. The AUC of the basic model for predicting POD was 0.854 (95% CI 0.780-0.928). After further including the SCINEXA score, the AUC of the extended model increased to 0.929 (95% CI 0.885-0.973). The internal validation of the Bootstrap model indicates good stability. Sensitivity analysis revealed that both intrinsic and extrinsic aging scores were associated with the occurrence of POD.
Conclusion: There is a significant correlation between the preoperative skin condition of elderly patients undergoing laparoscopic gastrointestinal tumor surgery and the occurrence of POD. The aging of the preoperative skin condition has certain predictive value for POD.
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