老年非心脏手术术后谵妄发生率及危险因素分析

Analysis of the incidence and risk factors of postoperative delirium in the elderly after non-cardiac surgery

目的调查老年非心脏手术术后谵妄的发生率及相关危险因素。方法采用前瞻性队列研究方法,选择四川省成都市三家综合医院2015年4～6月≥70岁行非心脏手术的病人为研究对象,于术前48 h内采用预先设计好的调查表收集病人人口学资料、基线资料及临床资料,术后1～7 d采用意识错乱评估方法评估谵妄的发生情况,分析术后谵妄发生率及其危险因素。结果本研究共有299例病人完成调查,50例病人发生术后谵妄,发生率为16. 72%,其中44例发生在术后3 d之内。多因素Logistic回归分析提示认知功能受损(OR=13. 01)、营养不良(OR=1. 89)、低日常生活活动能力(OR=1. 84)及严重合并症指数(OR=1. 76)是病人发生术后谵妄的独立危险因素。结论术前应注意筛查谵妄的高危病人,对存在认知功能障碍、营养不良、躯体功能障碍及严重合并症的老年人要提高预警,积极给予针对性干预,以期减少术后谵妄的发生。

Objective To investigate the incidence rate and risk factors of postoperative delirium in the elderly after non-cardiac surgery.Methods In this prospective cohort study,totally 299 patients aged 70 or older who had underwent non-cardiac surgeries in the selective hospital of Chengdu from April to June 2015 were involved in the present study.The patients were interviewed 2 days before surgery for the baseline data and perioperative characteristics,and underwent the assessment for delirium with the Confusion Assessment Method(CAM)on 1-7 d after operation.Results Delirium occurred in 50 patients(16.72%),and 88%(44/50)of the cases occurred within the first 3 days after operation.Multivariate Logistic regression analysis revealed that the independent risk factors of delirium were cognitive impairment(OR=13.01),poor nutrition(OR=1.89),decreased activity of daily life(ADL)(OR=1.84),higher charlson comcorbidity index(CCI)(OR=1.76).Conclusions The incidence rate of prospective delirium in the elderly after non-cardiac surgery is high.Cognitive impairment,poor nutrition,decreased ADL and higher CCI are the independent risk factors for postoperative delirium in elderly after non-cardiac surgery.Screening patients with high-risk perioperatively and giving targeted interventions may decrease the incidence of postoperative delirium.