创伤性休克病人术后谵妄的临床相关因素分析

Clinical relevant risk factors associated with postoperative delirium in traumatic shock patients

目的:探讨创伤性休克病人术后谵妄的临床相关影响因素。方法 :选择急诊手术的创伤性休克病人50例,男31例,女19例,年龄19～68岁。术前、术后12 h及术后第1、2、3天随访病人,用意识模糊谵妄评定法进行谵妄评估。记录病人血乳酸、血糖、颈内静脉血氧饱和度、血肌酐、血尿素氮和血半胱氨酸蛋白酶抑制剂C浓度值,检测术中失血量及术后谵妄的发生情况,建立数据库。根据是否发生谵妄分为谵妄组和对照组。结果:发生术后谵妄23例,发生率为46%。多因素logistic逐步回归分析发现病人年龄大、高乳酸血症、高血糖、颈内静脉血氧饱和度降低、急性肾功能损伤及术中失血量大均是谵妄的危险因素(P<0.05)。结论:年龄大、高乳酸血症、高血糖、颈内静脉血氧饱和度降低、急性肾功能损伤及术中大量失血为创伤性休克病人术后谵妄的危险因素。

Objective To explore the clinical relevant risk factors associated with postoperative delirium in traumatic shock patients. Methods Fifty traumatic shock patients undergoing emergency surgery were recruited （male 31, female 19, 19-68 years old）. The enrolled patients were interviewed at the day before surgery and 12 h after surgery. The same interviewer evaluated the patients with the confusion assessment method during the 1st, 2nd, 3rd postoperative days. Other information including blood lactic acid, glucose, creatinine, urea nitrogen, eystatin C, jugular venous oxygen saturation, the volume of intraoperative blood loss and the occurring of delirium were collected. The patients were divided into delirium group and control group. Results Delirium occurred in 23 patients during the first three postoperative days. The incidence of delirium was 46%. Multifactorial logistic stepwise regression analysis indicated that age, lactieacidemia, hyperglycemia, jugular venous oxygen saturation, acute renal injury and the volume of intraoperative blood loss were risk factors associated with delirium （P〈0.05）. Conclusions The risk factors of postoperative delirium in traumatic shock patients included advanced age, laeticaeidemia, hyperglycemia, decreased jugular venous oxygen saturation, acute renal injury and large amount of intraoperative blood loss.