老年患者腹部术后精神障碍的临床相关因素分析

Analysis on clinical relative factors with postoperative psychonosema in elderly patients after abdominal surgery

目的分析老年患者腹部术后精神障碍的临床相关因素。方法选择2008年1月～2010年12月山东省临朐县人民医院普外科收治的老年腹部手术患者382例,分析并比较术后精神障碍在年龄(<70岁、≥70岁)、性别、手术时间(≥90 min、<90 min)、麻醉方式(全身麻醉、连续硬膜外麻醉)、是否合并基础疾病、术后低蛋白血症、术后低氧血症、术后电解质紊乱、是否担心经济等因素间的分布情况;采用Logistic回归分析对术后精神障碍相关因素进行分析。结果 34例(8.9%)出现术后精神障碍症状,均得以控制并恢复正常。术后精神障碍发生率在年龄(<70岁、≥70岁)[6.1%(14/230)、13.2%(20/152)]、手术时间(≥90 min、<90 min)[14.5%(18/124)、6.2%(16/258)]、麻醉方式(全身麻醉、连续硬膜外麻醉)[18.8%(6/32)、8.0%(28/350)]、是否合并基础疾病[14.0%(19/136)、6.1%(15/246)]、术后低蛋白血症[12.7%(9/71)、8.0%(25/311)]、术后低氧血症[35.3%(30/85)、1.3%(4/297)]、术后电解质紊乱[36.7%(29/79)、1.7%(5/303)]、是否担心经济[16.8%(30/179)、2.0%(4/203)]等因素间进行比较,差异均有统计学意义(P<0.05或P<0.01);术后精神障碍发生率在性别[7.6%(16/210)、9.9%(17/172)]间比较,差异无统计学意义(P>0.05)。Logistic回归分析,结果表明,年龄≥70岁(OR=2.108,P<0.05)、手术时间≥90 min(OR=6.216,P<0.05)、全身麻醉(OR=5.485,P<0.05)、合并基础疾病(OR=1.470,P<0.05)、术后低氧血症(OR=1.585,P<0.05)、术后电解质紊乱(OR=7.648,P<0.05)、担心经济(OR=4.749,P<0.05)与术后精神障碍发生相关,且均为危险因素(OR>1.000)。结论老年患者腹部术后并发精神障碍是多种因素共同作用的结果,对于腹部手术的术后精神障碍,要预防为主,及早干预。

Objective To analyze clinical relative factors with postoperative psychonosema in elderly patients after abdominal surgery. Methods 382 elderly patients with abdominal operation from January 2008 to December 2010 in People＇s Hospital in Linqu County were selected; the distributed situation of postoperative psychonosema in the elements of age （〈70 years, ≥70 years）, gender, time of operation （≥90 min, 〈90 min）, way of anesthesia （general anesthesia, continual epidural anesthesia）, basic diseases, postoperative hypoalbuminemia, postoperative hypoxemia, postoperative electrolyte disturbance, fear of cost were analyzed and compared; Logistic analysis of regression was used to analyze the relative factors of postoperative psychonosema. Results 34 patients with postoperative psychonosema were found and the symptoms were controlled. The difference of postoperative psychonoscma rate in the elements of age （〈70 years, ≥70 years） [6.1% （14/230）, 13.2% （20/152）], time of operation （≥90 min, 〈90 min） [14.5% （18/124）, 6.2% （16/258）], way of anesthesia （general anesthesia, continual epidural anesthesia） [18.8% （6/32）, 8.0% （28/350）], basic diseases [14.0% （19/136）, 6.1% （15/246）], postoperative hypoalbuminemia [12.7% （9/71）, 8.0% （25/311）], postoperative hypoxemia [35.3% （30/85）, 1.3% （4/297）], postoperative electrolyte disturbance [36.7% （29/79）, 1.7% （5/303）], fear of cost [16.8% （30/179）, 2.0% （4/203）] were statistically significant （P 〈 0.05 or P 〈 0.01）; the difference of postoperative psychonosema rate in the elements of gender was not statistically significant （P 〉 0.05）. Age ≥ 70 years （OR = 2.108,P 〈 0.05）, time of operation ≥90 min （OR = 6.216,P 〈 0.05）, general anesthesia （OR = 5.485,P 〈 0.05）, with basic diseases （OR = 1.470,P 〈 0.05）, postoperative hypoxemia （OR = 1.585 ,P 〈 0.05）, postoperative electrolyte disturbance （OR = 7.648,P 〈 0.05）, fear of cost （OR = 4.749,P 〈 0.05） were found had correlation with postoperative psychonosema, and all of them were the risk factors （OR 〉 1.000） according to the Logistic analysis of regression. Conclusion There are mixed factors in the postoperative psychonosema in elderly patients after abdominal surgery, it is right to take early prevention and intervention measures.