营养控制状况评分与老年非心脏手术患者术后谵妄的相关性研究

Correlation between Controlling Nutritional Status and Postoperative Delirium in Elderly Patients Undergoing Non-cardiac Surgery.

目的探讨营养控制状况评分(controlling nutritional status,CONUT)与老年非心脏手术患者术后谵妄(postoperative delirium,POD)的相关性。方法本研究为观察性研究。纳入2019年3~8月在徐州医科大学附属医院择期行非心脏手术的老年患者530例。使用CAM(CAM-ICU)法评估术后3天内谵妄发生情况。采用多因素Logistic回归分析评估术后谵妄的危险因素。应用倾向性评分匹配分析(propensity score matching,PSM)探讨营养控制状况评分与老年非心脏手术患者术后谵妄的相关性。结果本试验中共122例(23%)患者发生术后谵妄。年龄(OR=1.047,95%CI:1.009~1.087,P=0.015)、手术时长(OR=1.003,95%CI:1.000~1.006,P=0.023)、术后入ICU(OR=2.123,95%CI:1.228~3.669,P=0.007)、术后发生手术相关并发症(OR=1.916,95%CI:1.117~3.287,P=0.018)是老年非心脏手术患者术后谵妄的独立危险因素。校正影响因素后,随着术前控制性营养状况评分增高,术后谵妄的风险明显增加(OR=1.156,95%CI:1.001~1.335,P=0.048),同时将混杂因素进行倾向性评分匹配后显示术前CONUT评分升高使术后谵妄的发生风险增高(OR=1.237,95%CI:1.031~1.485,P=0.022)。结论术前营养控制状况评分与老年非心脏手术患者术后谵妄相关。入院时营养不良的评估有助于识别术后谵妄的高危患者。

Objective To investigate the correlation between controlling nutritional status(CONUT)score and postoperative delirium(POD)in elderly patients undergoing non-cardiac surgery.Methods In this study,we used an observational study to enroll from March to August 2019,235 cases of non-cardiac surgery were enrolled in the affiliated hospital of Xuzhou medical university.According to the results of CAM(CAM-ICU),we diagnosed postoperative delirium.Risk factors for postoperative delirium were assessed using multivariate Logistic regression analysis.The correlation between controlling nutritional status and postoperative delirium in elderly patients undergoing non-cardiac surgery was investigated by propensity score matching analysis(PSM).Results Postoperative delirium occurred in 122 Patients(23%).Age(OR=1.047,95%CI:1.009-1.087,P=0.015),length of operation(OR=1.003,95%CI:1.000-1.006,P=0.023),postoperative ICU admission(OR=2.123,95%CI:1.228-3.669,P=0.007),postoperative complications(OR=1.916,95%CI:1.117-3.287,P=0.018)were independent risk factors for postoperative delirium.According to the results after correction factors,with increased preoperative CONUT score,a significantly increased risk of postoperative delirium(OR=1.156,95%CI:1.001-1.335,P=0.048),while the confounders propensity score matching display after preoperative CONUT score rise to increased risk of postoperative delirium(OR=1.237,95%CI:1.031-1.485,P=0.022).Conclusion Preoperative nutritional control score is associated with postoperative delirium in elderly patients undergoing non-cardiac surgery.Assessment of malnutrition on admission helps identify high-risk patients with postoperative delirium.