全麻手术患者术后谵妄发生情况及影响因素研究分析

Analysis on the Occurrence of Postoperative Delirium and Its Influencing Factors of Surgical Patients with General Anesthesia

目的:探究及分析全麻手术患者术后谵妄发生情况及影响因素,以为全麻患者术后谵妄防控措施的制订提供参考依据。方法:选取2020年1—12月在福州市长乐区医院进行全麻手术的650例患者为研究对象,统计其术后谵妄发生率,据此将患者分为术后谵妄组(n=119)和术后无谵妄组(n=531)。比较两组年龄、性别、手术时间、术前血红蛋白水平、合并糖尿病和/或高血压情况、手术类型、美国麻醉师协会(ASA)分级、文化程度、睡眠障碍情况、急性生理与慢性健康(APACHEⅡ)评分、抽烟史、饮酒史及血清白蛋白水平,采用多因素logistic回归分析全麻手术患者术后谵妄发生的影响因素。结果:650例全麻手术患者中发生119例术后谵妄,发生率为18.31%。两组性别、文化程度、手术类型、抽烟史及饮酒史比较,差异无统计学意义(P>0.05);术后谵妄组中年龄≥70岁、手术时间≥2 h、术前血红蛋白<100 g/L、合并糖尿病和/或高血压、ASA分级Ⅲ级、有睡眠障碍、APACHEⅡ评分≥15分及血清白蛋白水平<30 g/L的患者占比高于术后无谵妄组,差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄、手术时间、术前血红蛋白、合并糖尿病和/或高血压情况、ASA分级、睡眠障碍情况、APACHEⅡ评分及血清白蛋白水平是全麻手术患者术后谵妄发生的影响因素(P<0.05)。结论:全麻手术患者术后谵妄发生率较高,且年龄、手术时间、术前血红蛋白、合并糖尿病和/或高血压情况、ASA分级、睡眠障碍、APACHEⅡ评分及血清白蛋白水平等因素可影响其发生,其为全麻手术患者术后谵妄发生防控措施的制订提供参考依据。

Objective:To explore and analyze the occurrence and influencing factors of postoperative delirium in patients undergoing general anesthesia surgery,in order to provide reference for the development of prevention and control measures for postoperative delirium in general anesthesia patients.Method:A total of 650 patients underwent general anesthesia surgery at Changle District Hospital of Fuzhou from January to December 2020 were selected as the study subjects,the incidence of postoperative delirium was calculated,and based on this,patients were divided into postoperative delirium group(n=119)and postoperative non delirium group(n=531).The age,gender,operation time,preoperative hemoglobin level,diabetes and/or hypertension,operation type,American Society of Anesthesiologists(ASA)classification,education level,sleep disorder,acute physiology and chronic health evaluation(APACHEⅡ)score,smoking history,drinking history and serum albumin level were compared between the two groups.Multiple logistic regression analysis was used to investigate the influencing factors of postoperative delirium in patients underwent general anesthesia surgery.Result:Among 650 patients underwent general anesthesia surgery,119 experienced postoperative delirium,the incidence rate was 18.31%.There were no statistically significant differences in gender,educational levels,operation types,smoking and drinking history between two groups(P>0.05).In postoperative delirium group,the proportion of patients with age≥70 years,operation time≥2 h,preoperative hemoglobin<100 g/L,diabetes and/or hypertension,ASA gradeⅢ,sleep disorder,APACHEⅡscore≥15 points and serum albumin level<30 g/L were higher than those in postoperative non delirium group,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that age,operation time,preoperative hemoglobin,diabetes and/or hypertension,ASA classification,sleep disorder,APACHEⅡscore and serum albumin level were the influencing factors of postoperative delirium in patients underwent general anesthesia surgery(P<0.05).Conclusion:The incidence of postoperative delirium in patients undergoing general anesthesia surgery is high,and factors such as age,operation time,preoperative hemoglobin,diabetes and/or hypertension,ASA classification,sleep disorder,APACHEⅡscore and serum albumin level can affect its occurrence,which is the reference basis for formulating prevention and control measures for postoperative delirium in patients undergoing general anesthesia surgery.