术中血压变异性对老年腹腔镜结肠手术患者术后谵妄的影响

IMPACT OF INTRAOPERATIVE BLOOD PRESSURE VARIABILITY ON POSTOPERATIVE DELIRIUM IN ELDERLY PATIENTS UNDERGOING LAPAROSCOPIC COLON SURGERY

目的探讨术中血压变异性对老年腹腔镜结肠手术患者术后谵妄的影响。方法选择2021年1月—2022年2月在开滦总医院行腹腔镜结肠手术的所有老年患者(60~90岁),记录患者性别、年龄、身高体重、ASA分级、手术类型、麻醉时长,手术出血量,术中血压及术后发生谵妄情况,根据计算血压变异性指标三分位法将所有患者分为T1、T2、T3三组,统计学方法分析术中血压变异性与患者术后谵妄的相关性。结果三组患者一般资料差异无统计学意义(P>0.05),T1、T2、T3三组术后谵妄的发生率分别为9.26%、11.73%、23.46%,差异有统计学意义(P<0.05)。发生术后谵妄的人群与未发生谵妄人群相比,年龄和ASA分级差异有统计学意义(P<0.05)。校正混杂因素后,与T1组比较,T2、T3组发生术后谵妄的OR值(95%CI)分别为1.32(0.60~2.89)、3.81(1.81~8.03)。结论术中血压变异性的增加是POD独立危险因素,避免术中血压的波动,可以减少POD的发生。

Objective To investigate the effect of intraoperative blood pressure variability on postoperative delirium in elderly patients undergoing intestinal surgery.Methods Selected all elderly patients(60 to 90 years old)who underwent intestinal surgery in Kailuan General Hospital from January 2021 to February 2022,and recorded their gender,age,height and weight,ASA grade,type of surgery,duration of anesthesia,amount of surgical bleeding,intraoperative blood pressure,and postoperative delirium.All patients were divided into three groups T1,T2 and T3 according to the index of blood pressure variability with three-quartile method,and analyzed statistically the correlation between intraoperative blood pressure variability and postoperative delirium.Results There was no difference in general data among the three groups.The incidence of postoperative delirium of group T1,T2 and T3 was respectively 9.26%,11.73%and 23.46%,and the difference was statistically significant.There were statistically significant differences in age and ASA grade between patients with postoperative delirium and those without.After adjusting for confounding factors,compared with group T1,the OR(95%CI)of postoperative delirium in group T2 and T3 were respectively 1.32(0.60~2.89)and 3.81(1.81~8.03).Conclusion Intraoperative blood pressure variability was positively correlated with postoperative delirium.Avoiding intraoperative blood pressure fluctuation can reduce the occurrence of postoperative delirium.