髋关节置换术后早期认知功能障碍危险因素的巢式病例对照研究

Risk factors of early postoperative cognitive dysfunction in hip-replacement surgery:a nested case-control study

目的采用巢式病例对照研究方法分析该院髋关节置换术后患者早期认知功能障碍(POCD)的发生率及相关危险因素。方法对该院2010年1月至2015年11月髋关节置换的患者进行统计,资料完整者567例,对其中术后早期发生POCD的患者81例(病例组),采用巢式病例-对照研究方法,按照性别相同、年龄(±3岁)的原则,以1∶3的比例为病例组匹配对照组243病例,探讨受教育程度、高血压史、糖尿病史、慢性疼痛病史、饮酒、体质量指数(BMI)、麻醉方式、手术时间、血压波动、手术出血量、术后疼痛对术后早期POCD发生的影响。结果术后早期POCD的发病率为14.29%,单因素方差分析结果显示:高血压史、糖尿病史、饮酒、BMI、麻醉方式、血压波动(血压波动大于或小于基础30%)、手术出血量与POCD的发生不存在统计学关联(P>0.05),而受教育程度、手术时间、术前慢性疼痛病史、术后疼痛病史与POCD的发生呈正相关,且差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示:受教育程度、手术时间大于2h、术前慢性疼痛及术后疼痛与POCD发生呈正相关,且差异有统计学意义(P<0.05)。结论髋关节置换术后7dPOCD的发生率为14.29%;术前慢性疼痛、术后疼痛、受教育程度及手术时间大于2h是髋关节置换术后早期POCD的发生的危险因素。

Objective To analyze the incidence rate and related risk factors of early postoperative cognitive dysfunction（POCD） in hip‐replacement surgery by using the nested case‐control method .Methods The patients with hip‐replacement surgery in our hospital from January 2010 to December 2015 were performed the statistics ,including 567 cases of intact data ,in which 81 cases of POCD（case group） adopted the nested case‐control method ,and 243 cases were matched as the control group according to the prin‐cipleofthesamesexandage（＆#177;3yearsold）and1∶3proportion.Theinfluenceoftheeducationaldegree,hypertensionhistory,dia‐betes history ,chronic pain history ,drinking ,BMI ,anesthetic mode ,operative time ,blood pressure fluctuation ,intraoperative bleeding volume and postoperative pain on early POCD occurrence was investigated .Results The incidence rate of early POCD was 14 .29% .The one‐way anova analysis results revealed that the hypertension history ,diabetes history ,drinking ,BMI ,anesthetic mode ,blood pressure fluctuation 〉 or 〈 basic blood pressure 30% and intraoperative bleeding volume had no statistical correlation with POCD occurrence（P〉0 .05） ,while educational level ,operative time ,preoperative chronic pain history ,postoperative pain his‐tory had a positive relation with the POCD occurrence ,and the difference was statistically significant（P〈0 .05）;the multivariate Logistic regression analysis results showed that the educational level ,operative time〉2 h ,preoperative chronic pain and postopera‐tive pain had a positive correlation with the POCD occurrence ,and the difference was statistically significant （ P〈 0 .05 ） . Conclusion T he incidence rate of POCD on postoperative 7 d is 14 .29% .Preoperative chronic pain ,postoperative pain ,educational level and operative time〉2 h are the risk factors of early POCD occurrence .