高龄患者脊柱术后谵妄状态的高危因素分析

Analysis of risk factors for delirium in the elderly patients after spinal operation

目的:探讨高龄患者脊柱术后发生谵妄的高危因素。方法:回顾性分析自2007年4月至2011年4月间于北京大学第一医院骨科静脉全麻下行脊柱手术的年龄大于70岁的1 216例患者的基本病例资料,其中术后出现谵妄者116例,男62例,女54例,平均年龄75.3岁(70～92岁);颈椎前路手术36例,颈椎后路手术41例,腰椎后路手术39例。对患者的年龄、手术时间、术中出血、术后吗啡应用、术后甲基强的松龙应用、有无术后脑脊液漏、术后有无发热及卧床时间等临床相关因素进行单因素分析,并应用Logistic回归进行多因素分析。结果:单因素分析显示,手术时间(P=0.032)、术中出血量(P=0.013)、术后是否出现低氧血症(P=0.002)及发热(P=0.001)在谵妄与非谵妄患者之间差异有统计学意义。将上述单因素分析差异有统计学意义的变量与脑脊液漏、术后是否应用大剂量甲基强的松龙及吗啡进行多因素Logistic回归分析,结果表明,术后应用大剂量甲基强的松龙(P=0.002)及吗啡(P=0.005)、脑脊液漏(P=0.020)、低氧血症(P=0.005)均是术后谵妄发生的危险因素。结论:术中避免脑脊液漏和低氧血症,降低吗啡及甲基强的松龙用量可以减少谵妄状态的发生。

Objective：To explore the causes of high risk for the delirium of the elderly after spinal operation.Methods：In the study,116 cases of delirium were retrospectively analyzed from 1 216 patients aged more than 70 years who underwent spinal operation in general anesthesia from April 2007 to April 2011.Of the 116 patients,62 were male and 54 female,with an average age of 75.3 years,ranging from 70 to 92 years;36 underwent anterior cervical surgery,41 were treated by posterior cervical decompression surgery,and 39 had posterior lumbar decompression operation.Clinical features,such as gender,operation duration time,blood loss,analgesics drugs,the dosage of methylprednisolone,the leakage of cerebrospinal fluid,saturation of arterial oxygen and bed room periods were observed and the data were analyzed with the single factor risk analysis at first then multiple factors analysis performed by binary Logistic regression.Results：The single factor risk analysis showed that there are significant differences between delirium and non-delirium in operation duration（P=0.032）,blood loss（P=0.013）,hypoxemia（P=0.002） and fever（P=0.001） after operation.While multiple factors Logistic regression analysis indicated that the dosage of methylprednisolone（P=0.002） and morphine（P=0.005） after operation,the leakage of cerebrospinal fluid（P=0.020）,and hypoxemia（P=0.005） were the risk factors of delirium status after operation.Conclusion：The incidence of delirium status after spinal operation could be decreased by application of less dosage of morphine or methylprednisolone and to avoid hypoxemia and the leakage of cerebrospinal fluid during operation.