摘要
目的探讨围术期中性粒细胞与淋巴细胞比值(NLR)对老年胃肠肿瘤手术患者术后谵妄(POD)的预测价值。方法选取择期行腹腔镜胃肠肿瘤手术患者185例。术前采用简易智力状态检查量表(MMSE)评估患者认知功能;术后第1-7天采用意识模糊评估量表(CAM)评估患者POD发生情况,并分为POD组和NPOD组。记录患者术前的一般资料、围术期情况、术前1 d及术后1、3、5 d的部分实验室检查结果[中性粒细胞计数、淋巴细胞计数、C反应蛋白(CRP)等],并计算NLR值。采用多因素Logistic回归分析和受试者工作特征(ROC)曲线分析NLR对POD的预测价值。结果185例患者中,35例发生POD,合并吸烟、脑梗死病史患者的谵妄风险增加,差异有统计学意义(P<0.05)。POD组术前NLR、CRP水平高于NPOD组,术前血红蛋白水平低于NPOD组,术后1 d的CRP及术后3 d的NLR水平高于NPOD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术前NLR、CRP水平是POD发生的独立影响因素(P<0.05)。ROC曲线分析显示,术前NLR水平预测POD的曲线下面积(AUC)为0.726,最佳临界值为2.225,敏感度为65.7%,特异度为77.3%;术前CRP水平预测POD的AUC为0.649,最佳临界值为7.95 mg/L,敏感度为40.0%,特异度为96.7%;术前NLR预测POD的AUC大于CRP。结论腹腔镜胃肠肿瘤手术老年患者术前NLR、CRP水平是POD的预测指标,且术前NLR水平具有更好的预测价值。术前检测NLR水平对POD的早期预防和诊断有一定的价值。
Objective To explore the value of perioperative neutrophil to lymphocyte ratio(NLR)in predicting postoperative delirium(POD)of elderly patients with gastrointestinal tumor surgery.Methods A total of 185 elderly patients with selective laparoscopic surgery for gastrointestinal tumors were selected.Before surgery,the patient′s cognitive function was evaluated by the Mini-Mental State Examination(MMSE);from the first day to the seventh day after surgery,the incidence of POD in patients was evaluated by the Confusion Assessment Method(CAM),and they were divided into POD group and NPOD group.The general materials of the patients before surgery,perioperative conditions,and partial laboratory examination results[neutrophil count,lymphocyte count and C-reactive protein(CRP)]at 1 day before surgery and 1 day,3 and 5 days after surgery were recorded,and the NLR value was calculated.The predictive value of NLR for POD was analyzed by multiple factor Logistic regression analysis and receiver operating characteristic(ROC)curve.Results Among the 185 patients,35 patients had POD,and patients with histories of smoking and cerebral infarction had an increased risk of delirium(P<0.05).The preoperative NLR and CRP levels in the POD group were significantly higher than those in the NPOD group,the preoperative hemoglobin level was significantly lower than that in the NPOD group,and the CRP level at 1 day after operation and the NLR level at 3 days after operation were significantly higher than those in the NPOD group(P<0.05).Multi-factor Logistic regression analysis showed that preoperative NLR and CRP levels were the independent risk factors for the occurrence of POD(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of preoperative NLR level for predicting POD was 0.726,with the optimal critical value of 2.225,sensitivity of 65.7%and specificity of 77.3%;the AUC of preoperative CRP level for predicting POD was 0.649,with the optimal critical value of 7.95 mg/L,sensitivity of 40.0%and specificity of 96.7%;the AUC of preoperative NLR for predicting POD was greater than that of CRP.Conclusion Preoperative NLR and CRP levels are the predictive indicators for POD in elderly patients with laparoscopic surgery for gastrointestinal tumors,and preoperative NLR level has better predictive value.Preoperative detection of NLR level has certain value for early prevention and diagnosis of POD.
作者
戴晨
葛亚丽
高巨
吴瑞
DAI Chen;GE Yali;GAO Ju;WU Rui(Department of Anesthesiology,Subei People′s Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225001;Department of Anesthesiology,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225100)
出处
《实用临床医药杂志》
2023年第11期103-107,共5页
Journal of Clinical Medicine in Practice
基金
国家自然科学基金(82172190)
江苏省卫生计生委科研课题(Z201621)。
关键词
中性粒细胞与淋巴细胞比值
术后谵妄
老年患者
胃肠肿瘤
全身麻醉
C反应蛋白
neutrophil to lymphocyte ratio
postoperative delirium
elderly patients
gastrointestinal tumors
general anesthesia
C-reaction protein