胸外科老年患者术后谵妄的临床分析

目的：分析胸外科老年患者术后谵妄（POD）的发生率及相关危险因素。方法：对388例老年非心脏择期手术患者应用ICU谵妄诊断的意识状态评估法（CAM—ICU）进行POD评定，对肺部疾病组、食管疾病组及纵隔疾病组的POD发生率进行比较，并对食管疾病组中各危险因素进行分析。结果：食管疾病组POD的发生率为26．4％，明显高于肺部疾病组的7．0％和纵隔疾病组的2.3％。术前合并糖尿病、既往脑血管病史、手术时间长、术后中心静脉置管、术后鼻胃管留置时间长、术后鼻十二指肠管留置时间长以及术后SICU住院时间长是食管疾病患者POD的独立危险因素。结论：在胸外科老年病人的非心脏择期手术中，食管疾病患者POD的发生率显著高于其他疾病患者。术前合并糖尿病、既往脑血管病史的食管疾病患者是术后谵妄的易感人群，缩短手术时间、减少术后体内各管道的留置时间及SICU的住院时间可能会降低术后谵妄的发生率。

Clinical analysis of postoperative delirium in elderly patients of thoracic surgery

Objective:To analyze the incidence rate and related risk factors of postoperative delirium(POD) in elderly patients of thoracic surgery.Methods: POD was evaluated with the Confusion Assessment Method-Intensive Care Unit(CAM-ICU) in 388 elder patients underwent non-cardiac selective surgery,the POD incidence rate in esophageal disease group was compared with that in pulmonary diseases group and mediastinum diseases group,and various kinds of related risk factors were analyzed in esophageal disease group.Results:The incidence rate of POD in esophageal disease group was 26.4%,which was significantly higher than 7.0% in pulmonary diseases group and 2.3% in mediastinum diseases group.Diabetes mellitus,case history of cerebrovascular disease,long time of operation,tube detained in central veins,long time of gastric tube detained in vivo,long time of duodenum tube detained in vivo and long time stay in SICU were the independent risk factors of POD in esophageal disease group.Conclusion: The incidence rate of POD in esophageal disease is significantly higher than that in other disease in elderly patients underwent non-cardiac selective surgery of thoracic surgery.Diabetes mellitus and case history of cerebrovascular disease are risk factors to postoperative delirium.The incidence rate of POD in esophageal disease can be decreased by shortening of duration of operation,decreasing the time of various kinds of tube detained in vivo and length of stay in SICU.