老年患者人工髋关节置换术后谵妄与术前睡眠呼吸障碍的相关性分析

Relationship between postoperative delirium and preoperative sleep-disordered breathing in elderly patients after artificial hip replacement

目的分析老年患者人工髋关节置换术后出现谵妄与存在术前睡眠呼吸障碍(sleep-disordered breathing,SDB)的关系及危险因素。方法选取2012年6月~2017年12月在我院行人工髋关节置换手术老年患者130例,术前收集临床资料进行人口统计学分析,采用多导睡眠监测仪进行术前睡眠呼吸监测,根据睡眠暂停低通气指数(apnea hypopnea index,AHI)>5为存在SDB,观察并应用谵妄评定量表(CAM-CR)评估患者在手术后24~72h内是否出现谵妄,将患者分为谵妄组和无谵妄组,采用Logistic回归分析评估患者发生术后谵妄的相关危险因素,分析术后谵妄与术前睡眠呼吸障碍的相关性。结果 130例患者中有56例(43.1%)出现术后谵妄,谵妄组与非谵妄组年龄[(71.35±5.23)岁vs(63.76±3.56)岁]、长期吸烟[44.6%(25/56)vs 27.0%(20/74)]、AHI异常[50.0%(28/56)vs 28.4%(21/74)]、手术时间[(125±22)min vs(103±16)min]、术中失血量[(285±125)ml vs(210±102)ml]相比,差异均有统计学意义(P<0.05)。多变量Logistic回归分析显示,年龄[OR=1.116,95%CI=1.03~1.27,P=0.011]、AHI异常[OR=1.140,95%CI=1.02~1.25,P=0.000]、长期吸烟[OR=0.920,95%CI=0.82~2.10,P=0.037]、手术时间[OR=1.259,95%CI=0.76~2.15,P=0.042]、术中失血量[OR=1.710,95%CI=1.03~2.32,P=0.021]是术后谵妄发生的危险因素。Spearman相关分析显示,AHI指数与谵妄评分呈显著性正相关(r=0.741,P<0.05)。结论术前存在睡眠呼吸障碍是术后谵妄的独立危险因素,睡眠障碍的程度与术后谵妄严重程度呈正相关。

Objective To analyze the relationship between delirium and sleep-disordered breathing in elderly patients after artificial hip replacement, evaluate the risk factors of postoperative delirium. Methods 130 cases of elderly patients with artificial hip replacement were selected in our hospital from Jun 2012 to Dec 2017. Demographic analysis was carried out on preoperative clinical data, and polysomnography was adopted for preoperative sleep and respiratory monitoring. It was judged as sleep-disordered breathing（SDB） when AHI index〉5. The delirium rating scale（CAM-CR） was used to evaluate whether there was delirium at 24~72 h after the surgery. According to the CAM-CR result, the patients were divided into the delirium group and non-delirium group.Logistic regression analysis was used to evaluate the related risk factors of postoperative delirium, and the correlation between postoperative delirium and preoperative sleep-disordered breathing（SDB）. Results Among 130 patients, 56 cases（43.1%） occurred postoperative delirium. Age [（71.35±5.23）years vs（63.76±3.56）years], long-term smoking [44.6%（25/56） vs 27.0%（20/74）], composition of patients with abnormal AHI [50.0%（28/56） vs 28.4%（21/74）], operation time [（125±22）mins vs（103±16）mins], intraoperative blood loss [（285±125）ml vs（210±102）ml] had significantly statistical differences between the delirium group and non-delirium group（P〈0.05）. Multivariate logistic regression analysis showed that age[OR=1.116, 95%CI=1.03~1.27, P=0.011）, abnormal AHI（OR=1.140, 95%CI=1.02~1.25, P=0.000）, long-term smoking [OR=0.920, 95%CI=0.82~2.10, P=0.037）, operation time [OR=1.259, 95% CI=0.76~2.15, P=0.042）, and intraoperative blood loss（OR=1.710, 95%CI=1.03~2.32, P=0.021） were risk factors for postoperative delirium. Spearman correlation analysis showed significantly positive correlation between AHI index and delirium score（r=0.741,P〈0.05）. Conclusion Preoperative sleep-disordered breathing is an independent risk factor for postoperative delirium, and the degree of sleep-disordered breathing is positively correlated with the severity of postoperative delirium.