脑肿瘤术后谵妄危险因素分析

Risk factors of postoperative delirium in brain tumor surgery.

目的回顾性分析脑肿瘤患者术后谵妄的发生率及危险因素。方法依据Confusion Assessment Method(CAM)标准诊断谵妄。收集脑肿瘤患者术前、术后第1天临床资料及各项实验室检查和影像检查结果,评估脑肿瘤患者术后谵妄发生情况。结果共有16例脑肿瘤患者术后发生谵妄,所有患者年龄均大于70岁,70岁以上脑肿瘤患者术后谵妄发生率为12.1%。与非谵妄者比较,谵妄者术前头颅MRI显示明显的脑缺血改变,术后第1天谵妄者比非谵妄者血红蛋白浓度及红细胞压积显著下降。结论老年脑肿瘤患者术前多灶性脑缺血改变及术后第1天血红蛋白浓度和红细胞压积下降是术后发生谵妄的独立危险因素,保证足够的脑血流灌注从而降低术后谵妄发生应引起临床医生的充分重视。

Objective To determine the incidence and risk factors of postoperative delirium by retrospective analysis of patients with brain tumor. Methods The presence of delirium was determined by the Confusion Assessment Meth- od（CAM）. Clinical data, as well as laboratory and imaging data before suegery and at 1 day postoperatively were collect- ed. Postoperative delirium was evaluated. Results Postoperative delirium was found in 16 patients. All of them were over 70 years old and the incidence of delirium was 12. 1% in these patients. Preoperative cerebral ischemia levels and hemoglobin and hematocrit levels at 1 day after surgery were statistically significantly different between groups of the deliri- um and control. Patients with postoperative delirium had significant cerebral ischemia before surgery and significantly lower levels of hemoglobin and hematocrit at 1 day after surgery. Conclusion Preoperative multifocal cerebral ischemia in the elderly and low concentrations of hemoglobin and hematocrit 1 day after surgery were independent risk factors for postoperative delirium. Neurosurgeons should pay more attention to maintenance of adequate cerebral perfusion, hence to decrease incidence of postoperative delirium.