术前认知功能障碍对肝胆外科老年患者术后谵妄的影响

Effect of preoperative cognitive impairment on postoperative delirium in elderly patients undergoing hepatobiliary surgery

目的明确肝胆外科老年患者术前认知功能障碍的发生率,并探讨其与术后谵妄(POD)的关系。方法选取择期行腹腔镜下肝胆外科手术的老年患者216例,术前依据简易精神状态检查量表(MMSE)评分将患者分为术前认知功能正常组167例和术前认知功能障碍组49例,术后前3天内采用中文版3分钟谵妄诊断量表(3D-CAM)评估患者POD发生情况。比较两组患者一般资料以及POD发生情况,通过Logistic回归分析研究肝胆外科老年患者发生POD的危险因素,并采用受试者工作特征(ROC)曲线研究术前MMSE评分对POD的预测效能。结果两组患者的年龄、受教育年限、脑血管疾病、血清白蛋白、POD发生情况比较,差异有统计学意义,P<0.05或P<0.001。Logistic回归分析结果显示,术前认知功能障碍、年龄增加及血清白蛋白降低是肝胆外科老年患者发生POD的独立危险因素(P<0.05)。术前MMSE预测肝胆外科老年患者POD的ROC曲线下面积为0.774,取术前MMSE评分临界值21时,敏感度和特异度分别为71.8%和81.0%。结论肝胆外科老年患者的术前认知功能障碍发生率为22.7%。术前认知功能障碍与老年患者POD密切相关,是老年患者发生POD的独立危险因素之一,可作为术前风险分层的预测指标。

Objective To investigate the incidence of preoperative cognitive impairment in elderly patients undergoing hepatobiliary surgery and the relationship between preoperative cognitive impairment and postoperative delirium.Methods A total of 216 elderly patients who underwent laparoscopic hepatobiliary surgery were selected and divided into the normal group(167 cases)and the preoperative cognitive impairment group(49 cases)according to the score of the MMSE scale.The Chinese version of the 3D-CAM was used to assess the occurrence of POD in the first 3 days after surgery.The general data and the occurrence of POD were compared between the two groups.The risk factors of POD in elderly patients with hepatobiliary surgery were studied by logistic regression,and the predictive efficacy of MMSE score on POD was studied by ROC curve.Results There were statistically significant differences in age,years of education,cerebrovascular diseases,serum albumin and POD between the two groups(P<0.05 or P<0.001).Logistic regression showed that preoperative cognitive impairment,increasing age and decreasing serum albumin were independent risk factors for POD in elderly patients undergoing hepatobiliary surgery(P<0.05).The area under ROC curve of preoperative MMSE prediction of POD in elderly patients with hepatobiliary surgery was 0.774.When the preoperative critical MMSE score was 21,the sensitivity and specificity were 71.8%and 81.0%,respectively.Conclusion The incidence of preoperative cognitive impairment was 22.7%in elderly patients with hepatobiliary surgery.Preoperative cognitive impairment is closely related to postoperative delirium in elderly patients,and is one of the independent risk factors for postoperative delirium in elderly patients,and can be used as a predictor of preoperative risk stratification.