不同人格气质类型对老年患者术后谵妄的影响

Effects of different types of personality on postoperative delirium in elderly patients

目的本研究探讨不同人格气质类型对老年患者术后谵妄的影响及探讨不同人格气质类型与外周血中炎性因子白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)的变化是否有关联。方法采用艾森克人格(EPQ)问卷对108例老年骨科手术患者术前进行人格分析,确定术后谵妄发生的时间及谵妄的类型。发生术后谵妄的患者,待症状消除后的24 h内,使用比内-西蒙智力量表再次测量患者的智力及认知水平,并对手术前后结果进行统计分析。检测患者术前及术毕0、24、48、72 h不同时间点外周血中IL-6、TNF-α、IL-1β水平,用统计学方法比较内外向患者术毕各时间点和术前IL-6、TNF-α、IL-1β的浓度。结果内向型患者54例,发生谵妄者8例;外向型患者54例,发生谵妄者2例,2组患者谵妄发生率差异有统计学意义(P<0.05)。内向型组术后外周血中炎性因子IL-6、TNF-α、IL-1β均比外向型组高(P<0.05),患者发生谵妄前后智力及认知水平差异无统计学意义(P>0.05)。结论不同人格气质类型对老年患者术后谵妄存在影响,内向型患者尤其是内向不稳定性患者更容易发生谵妄。炎性因子可能是参与术后谵妄发生的因素之一。

Objective To investigate the inf luence of different types of personality and temperament on postoperative delirium in elderly patients and to study the correlations between types of personality and temperament and changes of levels of peripheral inf lammatory factor interleukin-6(IL-6),tumor necrosis factor(TNF-α),and interleukin-1β(IL-1β)in peripheral blood.Methods One hundred and eight elderly patients scheduled for orthopedic surgery were surveyed by the Eysenck Personality Questionnaire(EPQ)before surgery.Patients with postoperative delirium had their intelligence and cognition re-measured using the Binet Simon Intelligence Scale 24 hours after disappearance of symptoms.The preoperative and postoperative results were statistically analyzed.The levels of IL-6,TNF-αand IL-1βin the peripheral blood of the patients before surgery and at the 0 h,24 h,48 h and 72 h after surgery were detected and compared between patients with different types of personality.Results Among the 54 introverted patients,delirium occurred in 8 cases,compared with 2 cases among the 54 extraverted patients.There was statistically significant difference in the incidence of delirium between the two groups(P<0.05),but there was no significant difference in preoperative IL-6 levels between the two types of patients(P>0.05),despite the higher postoperative levels of IL-6,TNF-αand IL-1βamong introverted patients(all P<0.05).In patients with delirium,intelligence and cognitive levels hardly changed after operation(P>0.05).Conclusion The types of personality and temperament have some inf luence on postoperative safety in elderly patients.The incidence of postoperative delirium in introverted patients is higher than in extroverted ones.Inf lammatory factors may be involved in the occurrence of postoperative delirium.