杜克麻醉抵抗量表在老年髋关节置换术术后谵妄中的预测价值

Predictive value of Duke anesthesia resistance scale for postoperative delirium in elderly patients undergoing hip replacement

目的探讨杜克麻醉抵抗量表(DARS)在老年髋关节置换术(THA)术后谵妄(POD)中的预测价值。方法采用回顾性研究,以2020年1月至2023年4月在合肥市第三人民医院接受择期THA手术老年患者为研究对象,按照谵妄诊断量表(CAM)对术后3 d谵妄情况进行评估。将患者分为术后谵妄组(n=27)和非术后谵妄组(n=149)。通过电子病历系统获取患者一般资料,包括年龄、性别、体重指数、合并症数量、手术类型、美国麻醉师协会(ASA)分级、术前简易精神状态量表(MMSE)得分、手术时间、麻醉时间、术中用药和出血量。通过最低有效呼气末肺泡浓度(MAC_(bar))、呼气末浓度平均值(^(-)E TAC)和脑电双频指数(BIS)计算DARS得分。统计所有患者术后住院时间、术后28 d新发心脑血管事件和术后感染事件。结果两组性别构成比、手术类型、ASA分级、术前MMSE得分比较,差异均无统计学意义(P>0.05);术后谵妄组的年龄、合并症数量分别为(76.74±7.23)岁、(2.22±0.42)种,均高于非术后谵妄组[(65.56±6.04)岁、(1.73±0.44)种],差异均有统计学意义(P<0.05)。术后谵妄组与非术后谵妄组的手术时间、麻醉时间、出血量比较,差异均无统计学意义(P>0.05);术后谵妄组DARS得分为(23.30±4.51)分,低于非术后谵妄组[(36.65±8.07)分],差异有统计学意义(P<0.05)。二元Logistics回归分析结果显示,年龄、合并症数量和DARS得分均是老年THA术后谵妄的独立影响因素(P<0.05)。ROC分析结果显示,DARS用于预测老年THA术后谵妄曲线下面积为0.924,95%CI为0.882~0.967,最佳截断值为30分,此时敏感度为0.895,特异度为0.864。两组术后28 d内新发心脑血管事件和感染事件发生率比较,差异均无统计学意义(P>0.05),DARS<30分患者住院时间为(10.53±2.71)d,高于DARS≥30分患者[(7.96±2.30)d],差异有统计学意义(P<0.05)。结论DARS可准确预测THA术后谵妄,且对患者短期预后有一定影响,适宜在临床中推广应用。

Objective To investigate the predictive value of Duke anesthesia resistance scale(DARS)for postoperative delirium in elderly patients undergoing total hip arthroplasty(THA).Methods A retrospective study was conducted.The elderly patients who underwent elective THA surgery in Hefei Third People's Hospital from January 2020 to April 2023 were selected as the research subjects.The delirium diagnostic scale(CAM)was used to evaluate the postoperative 3 d postoperative delirium.The patients were divided into the postoperative delirium group(n=27)and the non-postoperative delirium group(n=149).Through the electronic medical record system to obtain general information of patients,including preoperative data and intraoperative data,preoperative data included age,gender,body mass index,number of complications,type of surgery,American society of anesthesiologists(ASA)classification,and preoperative mini-mental state examination(MMSE)score;intraoperative data included operation time,anesthesia time,intraoperative medication and blood loss.The DARS score was calculated by minimum effective end-expiratory alveolar concentration(MAC_(bar)),mean end-expiratory concentration(^(-)E TAC)and bispectral index(BIS).The postoperative hospital stay,new cardiovascular and cerebrovascular events and postoperative infection events at 28 days after operation were counted.Results There was no statistically significant difference in gender composition ratio,operation type,ASA classification and preoperative MMSE score between the two groups(P>0.05).The age and number of complications in the postoperative delirium group were(76.74±7.23)years old and(2.22±0.42)kinds,respectively,which were higher than those in the non-postoperative delirium group[(65.56±6.04)years old and(1.73±0.44)kinds],and the differences were statistically significant(P<0.05).There were no statistically significant differences in operation time,anesthesia time and bleeding volume between the postoperative delirium group and the non-postoperative delirium group(P>0.05).The DARS score of the postoperative delirium group was(23.30±4.51)points,which was lower than that of the non-postoperative delirium group[(36.65±8.07)points],and the difference was statistically significant(P<0.05).ROC analysis showed that the area under the curve of DARS for predicting POD after THA in the elderly was 0.924,95%CI was 0.882-0.967,and the optimal cutoff value was 30 points.At this time,the sensitivity was 0.895 and the specificity was 0.864.There was no statistically significant difference in the incidence of new cardiovascular and cerebrovascular events and infection events between the two groups within 28 days after operation(P>0.05).The hospitalization time of patients with DARS<30 points was(10.53±2.71)d,which was higher than that of patients with DARS≥30 points[(7.96±2.30)d],and the difference was statistically significant(P<0.05).Conclusion DARS can accurately predict POD after THA,and has a certain impact on the short-term prognosis of patients,which is suitable for clinical application.