老龄患者术后谵妄的发生率及危险因素分析

目的探讨老龄非心脏手术患者术后谵妄的发生率及危险因素.方法选择2010年3月～6月期间,年龄≥65岁择期非心脏手术患者共226例,术前访视病人,手术结束当日、术后1、2、3 d密切随访患者,用谵妄评定法（confusion assessment method,CAM）进行谵妄评估.按设计调查表祥细记录患者一般情况、合并症、麻醉方式、手术时间、术中失血量、术中输库存血量、术后疼痛评分及谵妄的发生情况,建立数据库、根据是否发生谵妄分为谵妄组和对照组.结果有42例术后发生谵妄,发生率为18.58%.多因素Logistic逐步回归分析结果表明,年龄、术前合并肺心病、全身麻醉、手术时间≥3 h、术后疼痛评分=4分为谵妄的危险因素.结论老龄、术前合并肺心病、全身麻醉、长时间手术、剧烈疼痛是老龄术后谵妄的独立危险因素.缩短手术时间、有效的术后镇痛可能会降低老龄患者术后谵妄的发生率.

The Incidence Rate and the Risk Factors of Postoperative Delirium in Elderly Noncardiac Surgical Patients

Objective To explore the incidence rate and the risk factors of postoperative delirium in elderly noncardiac surgical patients.Methods 226 patients,aged 65 or older,undergoing elective noncardiac surgery were recruited from March to June,2010.The patients with delirium or diagnosed as dementia,depression,and cognitive dysfunction before operation were ruled out in this study.The enrolled patients were interviewed at the day before surgery.The same interviewer evaluated the patients with the Confusion Assessment Method（CAM）during the first three postoperative days.Other informations including previous medical history,complications,anesthesia methods,duration of operations,blood loss,blood transfusion,postoperative pain scoring and the incidence of delirium were also recorded.226 patients were divided into two groups：delirium group and control group.Results Delirium occurred in 42 patients at some time-points during the first three postoperative days.The incidence rate of delirium was 18.58%.The multi-factors Logistic stepwise regression analysis indicated that the risk factors of delirium included advanced age,cor pulmonale,general anaesthesia,long duration of operations≥3 h,postoperative pain score=4.Conclusion Advanced age,cor pulmonale,general anaesthesia,long duration of operations,postoperative pain are independent risk factors of postoperative delirium in elderly noncardiac surgical patients.The incidence rate of postoperative delirium can be reduced by shortening of duration of operation and postoperative analgesia.