术中低血压和血压波动对老年患者外科腹腔镜术后早期谵妄的影响

Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after laparoscopic surgery

目的研究术中低血压和血压波动对老年患者外科腹腔镜术后早期谵妄的影响。方法 选取2012年6月至2015年8月间符合排除/纳入标准的接受腹腔镜手术的患者。统计患者年龄、性别、基础疾病等基线资料，记录患者手术情况，利用谵妄评估量表评估手术前后患者的认知状况，测量术中的平均动脉压与收缩压，计算血压数值的变异度，统计分析术后早期谵妄的影响因素，利用多重回归模型验证相关结果。结果 共213例患者入组研究，术后第1天63例（29.6%）患者发生谵妄，术后第2天61例（28.6%）患者发生谵妄。术后第1天谵妄患者手术时间、术中失血量高于非谵妄患者，差异具有统计学意义（P〈0.05）。谵妄与非谵妄患者中相对低血压（减少20%、30%或40%）或绝对低血压（平均动脉压〈50 mmHg）发生率差异无统计学意义（P〉0.05）。术中血压变异是术后谵妄的危险因素。结论 术中血压降低与术后谵妄发生无显著关联，术中血压波动与早期术后谵妄发生密切相关。

Objective To investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing laparoscopic surgery with prospective cohort study. Methods Study subjects were patients, 〉 65 years of age, undergoing laparoscopic surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured, and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analyzed with t - test, two-sample proportion test, and ordered logistic regression muhivariable model, including correction for multiple comparison. Results Data from 213 patients with a mean age of 73.6 years （ SD 6. 1 ） were studied. Of these 63 （29. 6% ） developed delirium on day 1 and 61 （28.6%） on day 2. Relative hypotension （decreases by 20% , 30% , or 40% ） or absolute hypotension [ mean arterial pressure （MAP） 〈 50 mmHg] were not significantly associated with postoperative delirium, nor was the duration of hypotension （MAP 〈 50 mmHg）. Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. Conclusions These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.