老年高血压脑出血术后谵妄发生和危险因素分析

Investigation of delirium in postoperative elderly patients with hypertensive intracerebral hemorrhage and the risk factors

目的探究老年高血压脑出血术后谵妄发生情况和危险因素。方法选取2020年1月至2022年1月在我院进行高血压脑出血手术的老年患者62例,根据患者术后48 h内是否发生谵妄分为发生谵妄组(n=28)和未发生谵妄组(n=34),回顾性分析患者的临床资料,探究老年高血压脑出血患者术后出现谵妄的危险因素,并对患者预后进行分析。结果62例老年患者中术后谵妄发生率为45.16%(28/62);经单因素分析显示,术前,发生谵妄组患者年龄明显大于未发生谵妄组(P<0.05);术中,发生谵妄组患者手术时间、麻醉持续时间明显长于未发生谵妄组(P<0.05),术中最低平均动脉压低于未发生谵妄组(P<0.05);术后,发生谵妄组术后低氧血症比例、机械通气比例、术后带管时间均明显高于未发生谵妄组(P<0.05),格拉斯哥昏迷评分(GCS)、血氧饱和度均明显低于未发生谵妄组(P<0.05);经多因素分析显示,年龄大、术后发生低氧血症、GCS评分低、血氧饱和度低是老年高血压脑出血患者术后发生谵妄的危险因素(P<0.05);术后谵妄组患者术后3个月存活率与术后未发生谵妄组比较,差异无统计学意义(P>0.05)。结论老年高血压脑出血术后出现谵妄的风险较高,其受多种因素影响,与患者术后存活率密切相关,临床上可根据患者实际情况进行干预指导,预防谵妄的发生。

Objective To investigate the occurrence of delirium in postoperative elderly patients with hypertensive intracerebral hemorrhage and its risk factors.Methods A total of 62 elderly patients who underwent hypertensive intracerebral hemorrhage surgery in our hospital from January 2020 to January 2022 were selected as the research subjects.According to the presence or absence of delirium within 48 hours after surgery,they were allocated to delirium group(n=28)and non-delirium group(n=34).The clinical data of patients were retrospectively analyzed,and the risk factors for postoperative delirium in elderly patients with hypertensive intracerebral hemorrhage were explored.The prognosis was analyzed.Results The incidence of postoperative delirium in our cohort was 45.16%(28/62).Univariate analysis showed that before surgery,the age of patients in delirium group was significantly older than that in non-delirium group(P<0.05).During the surgery,the surgical time and duration of anesthesia in delirium group were significantly longer than those in non-delirium group(P<0.05),and the lowest mean arterial pressure during the surgery was significantly lower than that in non-delirium group(P<0.05).After surgery,the proportion of postoperative hypoxemia and mechanical ventilation and postoperative intratracheal tube time in delirium group were significantly higher or longer than those in non-delirium group(P<0.05),while the Glasgow Coma Scale(GCS)score and blood oxygen saturation were significantly lower than those in non-delirium group(P<0.05).Multivariate Logistic regression analysis revealed that older age,presence of postoperative hypoxemia,low GCS score,and low blood oxygen saturation were risk factors for postoperative delirium in elderly patients with hypertensive intracerebral hemorrhage(P<0.05).There was no significant difference in the survival rate of patients at 3 months after surgery between postoperative delirium group and postoperative non-delirium group(92.86%vs 94.12%,P>0.05).Conclusion The occurrence of delirium in postoperative elderly patients with hypertensive intracerebral hemorrhage is high,which is affected by various factors and closely related to the postoperative survival.Clinically,it is necessary to carry out intervention guidance according to the actual situation of patients to prevent the occurrence of delirium.