老年髋部骨折病人术后认知功能与术中组织氧饱和度的关系

Relationship between postoperative cognitive dysfunction and intraoperative tissue oxygen saturation in elderly patients with hip fracture

目的 分析术中组织氧饱和度与老年髋部骨折病人术后认知功能障碍(POCD)的相关性。方法 选取2020年1月至2022年6月本院诊治的老年髋部骨折病人215例,根据国际术后认知功能障碍研究组(ISPOCD)确定的“Z评分”法将病人分为POCD组(n=42)和非POCD组(n=173)。比较2组脑组织氧饱和度(SctO_(2))和下肢肌肉组织氧饱和度(SmtO_(2))的水平,采用Logistic回归模型分析老年髋部骨折病人POCD发生的危险因素;绘制ROC曲线分析相关因素对POCD的预测价值。结果 POCD组年龄、糖尿病病人占比、术中出血量、麻醉时间、手术时间、术后疼痛评分、hs-CRP水平均高于非POCD组,SctO_(2)水平和受教育年限则低于非POCD组(P<0.05)。Logistic回归分析显示,年龄≥80岁、合并糖尿病、术中出血量较多、低SctO_(2)是影响老年髋部骨折病人POCD发生的危险因素(P<0.05)。ROC曲线分析表明,以68%为最佳截断点,SctO_(2)预测老年髋部骨折病人术后第7天发生POCD的灵敏度、特异度和AUC分别为90.70%、90.17%和0.809(P<0.05)。结论 低SctO_(2)、年龄≥80岁、合并糖尿病、术中出血量较多是老年髋部骨折病人POCD的危险因素,且SctO_(2)对POCD具有很好的预测价值。

Objective To analyze the correlation between intraoperative tissue oxygen saturation and postoperative cognitive dysfunction(POCD)in the elderly patients with hip fracture.Methods A total of 215 elderly patients with hip fracture treated in our hospital from January 2020 to June 2022 were selected and divided into POCD group(n=42)and non-POCD group(n=173)according to Z score method determined by the International Study of Postoperative Cognitive Dysfunction(ISPOCD).The levels of cerebral tissue oxygen saturation(SctO_(2))and lower limb muscle tissue oxygen saturation(SmtO_(2))were observed and compared between the two groups.Logistic regression model was used to analyze the risk factors of POCD in the elderly patients with hip fracture.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of SctO_(2) for POCD in the elderly patients with hip fracture.Results The age,proportion of the patients with diabetes,intraoperative blood loss,anesthesia time,operation time,postoperative pain score and high sensitivity C reactive protein(hs-CRP)level were significantly higher,while the level of SctO_(2) and the years of education were significantly lower in POCD group than those in non-POCD group(P<0.05).Logistic regression analysis showed that aged≥80 years old,complicated with diabetes mellitus,high level of intraoperative blood loss and low level of SctO_(2) were the risk factors for POCD(P<0.05).According to ROC curve analysis,SctO_(2)(68%as the optimal cut-off point)showed predictive value for POCD in the elderly patients with hip fracture,with the sensitivity,specificity and AUC of 90.70%,90.17%and 0.809(95%CI:0.742-0.875),respectively.Conclusions Low SctO_(2),aged≥80 years old,complicated with diabetes and high level of intraoperative blood loss are the risk factors for POCD in the elderly patients with hip fracture.SctO_(2) has a good predictive value for POCD in the elderly patients with hip fracture.