胰十二指肠切除术患者术后谵妄的危险因素分析

Risk factors analysis for delirium patients after pancreaticoduodenectomy

目的 探讨胰十二指肠切除术后发生谵妄的危险因素,为制定临床护理干预方法提供参考依据。方法 选取2014年1月—2021年7月于南京医科大学附属淮安第一医院行胰十二指肠手术的269例患者为调查对象,将其中19例诊断为谵妄的患者作为病例组(谵妄组),250例非谵妄患者为对照组(非谵妄组)。采用单因素分析及二元Logistic回归模型分析术后谵妄发生的相关危险因素。结果 单因素分析结果显示,年龄、术前睡眠障碍、手术时间、术中出血量、术后机械通气、术后血红蛋白、术后白蛋白、术后中度及以上疼痛、术后发热是影响胰十二指肠切除术后发生谵妄的相关因素(P<0.05);多因素Logistic回归分析结果显示,年龄、术前睡眠障碍、手术时间、术后白蛋白、术后中度及以上疼痛是影响胰十二指肠切除术后发生谵妄的危险因素(P<0.05)。谵妄患者与非谵妄患者在术后并发症、术后住院时间、住院总费用、治疗满意度方面比较,差异有统计学意义(P<0.05)。结论 对手术时间较长的高龄患者改善术前睡眠障碍、增加术后营养及术后有效镇痛是预防胰十二指肠切除术后发生谵妄的关键,应根据患者具体情况,选择个体化、综合性的护理预防措施。

Objective To investigate the risk factors of delirium patient after pancreaticoduodenectomy and to provide reference for clinical nursing intervention methods. Methods A total of 269 patients who underwent pancreaticoduodenal surgery in Huai’an First Hospital Affiliated to Nanjing Medical University from January 2014 to July 2021 were selected as the subjects, 19 patients diagnosed with delirium were enrolled as the case group(delirium group), 250 patients without delirium were enrolled as the control group(non-delirium group). Univariate analysis and binary Logistic regression model were used to analyze the risk factors of postoperative delirium. Results Univariate analysis showed that age, preoperative sleep disturbance, operative time, intraoperative blood loss, postoperative mechanical ventilation, postoperative hemoglobin, postoperative albumin, postoperative moderate pain and postoperative fever were the related factors affecting postoperative delirium(P <0.05). Multivariate Logistic regression analysis showed that, age, preoperative sleep disturbance, operation time, postoperative albumin and moderate or above postoperative pain were the risk factors for delirium after pancreaticoduodenectomy(P<0.05). There were statistically significant differences in postoperative complications, postoperative length of hospital stay, total hospitalization cost and treatment satisfaction level between delirium patients and non-delirium patients(P <0.05). Conclusion The key to prevent delirium after pancreaticoduodenectomy was to improve preoperative sleep disturbance, increase postoperative nutrition and postoperative eff ective analgesia for elderly patients with long operation time. Individualized and comprehensive nursing and preventive measures should be inplemented according to the specific situation of patients.