帕金森病患者立体定向脑内核团毁损术后谵妄的发生特征及影响因素

Characteristics and Influencing Factors of Postoperative Delirium after Stereotactic Intracerebral Nucleus Disruption Surgery for Patients with Parkinson′s Disease

目的分析帕金森病患者立体定向脑内核团毁损术后谵妄的发生特征及影响因素。方法收集2014年12月至2021年12月首都医科大学宣武医院收治的349例帕金森病患者的临床资料,均行立体定向脑内核团毁损术治疗,术后采用重症监护病房意识模糊评估量表对患者进行谵妄评估,记录患者谵妄发生情况。收集所有患者人口学及临床相关资料,采用单因素和多因素Logistic回归分析帕金森病患者立体定向脑内核团毁损术后谵妄的发生特征及影响因素。结果本研究共105例患者出现术后谵妄,发生率为30.09%;谵妄发生距离手术结束时间8.5~170.0 h[38.5(25.5,62.0)h];患者术后谵妄持续时间5.5~176.0 h[18.6(12.5,46.0)h]。术后谵妄组患者高血压史、糖尿病史、术中体外循环、术中低血压、术后机械通气比例均高于术后无谵妄组[68.57%(72/105)比53.28%(130/244)、45.71%(48/105)比30.74%(75/244)、29.52%(31/105)比17.21%(74/244)、27.62%(29/105)比15.57%(38/244)、28.57%(30/105)比8.61%(21/244)](P<0.05或P<0.01),术后氧合指数低于术后无谵妄组[(260±30)mmHg(1 mmHg=0.133 kPa)比(305±32)mmHg](P<0.01),两组纽约心脏病协会心功能分级、美国麻醉医师协会(ASA)麻醉分级、麻醉方法分布比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压史、ASA麻醉分级(Ⅳ级)、麻醉方法(全身麻醉)、术中体外循环、术中低血压是帕金森病患者术后谵妄的相关影响因素(OR=1.346,95%CI 1.015~1.758;OR=2.528,95%CI 1.854~3.257;OR=1.969,95%CI 1.428~3.146;OR=1.694,95%CI 1.023~2.157;OR=2.141,95%CI 1.348~2.986)(P<0.05或P<0.01)。结论帕金森病立体定向脑内核团毁损术后谵妄发生率高,多在术后1周内发生,且持续时间也多在1周内,术后谵妄的发生受高血压史、ASA麻醉分级(Ⅳ级)、麻醉方法(全身麻醉)、术中体外循环、术中低血压等因素影响,医护人员可据此制订相应防治策略。

Objective To analyze the characteristics and factors influencing the occurrence of postoperative delirium after stereotactic intracerebral nucleus disruption for patients with Parkinson′s disease(PD).Methods Clinical data of 349 PD patients treated with stereotactic intracerebral nucleus disruption in the Xuanwu Hospital of Capital Medical University from Dec.2014 to Dec.2021 were collected,and the patients were assessed for delirium using the confusion assessment method for the intension care unit after surgery,and the occurrence of delirium was recorded.Demographic and clinically relevant data were collected from all patients,and univariate and multivariate Logistic regression analyses were used to explore the factors influencing postoperative delirium in PD patients undergoing stereotactic intracerebral nucleus disruption.Results A total of 105 patients developed postoperative delirium after treatment with stereotactic intracerebral disruption,with an incidence of 30.09%.The onset of delirium was 8.5-170.0 h from the end of surgery[38.5(25.5,62.0)h],duration of postoperative delirium 5.5-176.0 h[18.6(12.5,46.0)h].The rates of hypertension history,diabetes history,intraoperative extracorporeal circulation,intraoperative hypotension and postoperative mechanical ventilation in the postoperative delirium group were higher than those in the postoperative delirium-free group[68.57%(72/105)vs 53.28%(130/244),45.71%(48/105)vs 30.74%(75/244),29.52%(31/105)vs 17.21%(74/244),27.62%(29/105)vs 15.57%(38/244),28.57%(30/105)vs 8.61%(21/244)](P<0.05 or P<0.01),Postoperative oxygenation index was lower than that of the delirium-free group[(260±30)mmHg vs(305±32)mmHg](P<0.01),and there were significant differences in the distributions of cardiac function grades of the New York Heart Association,anesthesia grades of the American Society of Anesthesiologists(ASA)and anesthesia methods between the two groups(P<0.05).Multivariate Logistic regression analysis showed that history of hypertension,ASA anesthesia grade(Ⅳ),anesthesia method(general anesthesia),intraoperative extracorporeal circulation,intraoperative hypotension were the influencing factors for postoperative delirium in PD patients(OR=1.346,95%CI 1.015-1.758;OR=2.528,95%CI 1.854-3.257;OR=1.969,95%CI 1.428-3.146;OR=1.694,95%CI 1.023-2.157;OR=2.141,95%CI 1.348-2.986)(P<0.05 or P<0.01).Conclusion The incidence of postoperative delirium after stereotactic intracerebral nucleus disruption for PD patients is high,mostly occurring within 1 week after surgery and lasting within 1 week.The occurrence of postoperative delirium is influenced by the history of hypertension,ASA anesthesia classification(grade IV),anesthesia method(general anesthesia),intraoperative extracorporeal circulation,intraoperative hypotension,and other factors,according to which the medical workers can develop appropriate prevention and treatment strategies.