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投稿时间:2022-05-04 网络发布日期:2023-01-20
投稿时间:2022-05-04 网络发布日期:2023-01-20
中文摘要: 目的探讨术中脑氧饱和度(rSO2)预测老年开胸手术患者术后谵妄(POD)的临床价值。
方法回顾性纳入2018年6月至2021年12月邯郸市中心医院住院治疗的378例开胸手术老年患者,依据术后3d是否发生POD,分为POD组73例(19.31%)、非POD组305例(80.69%)。提取患者临床资料,采用多因素logistic回归分析POD发生的危险因素,采用ROC曲线评定rSO2预测POD的效能。
结果单因素分析显示,POD组年龄>75岁、糖尿病、机械通气、术后转ICU、睡眠障碍的发生率以及rSO2较基础值降低的最大百分数(rSO2%max)高于非POD组,术中rSO2均值低于非POD组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄>75岁(OR=1.255,P=0.013)、术前睡眠障碍(OR=1.500,P=0.027)、rSO2%max>22.75%(OR=1.833,P=0.005)是老年开胸手术患者发生POD的独立危险因素。ROC曲线表明,rSO2%max预测老年开胸手术患者发生POD的AUC最高(0.892),其次为年龄(0.786),睡眠障碍预测的效能最低(0.731)。
结论术中rSO2降低是老年开胸手术患者发生POD的独立危险因素,监测rSO2变化有助于预测POD发生风险并早期干预。
Abstract:ObjectiveToexploretheclinicalvalueofintraoperativeregionalcerebraloxygensaturation(rSO2)inpredictingpostoperativedelirium(POD)inelderlypatientsundergoingthoracotomy.
MethodsAtotalof378elderlypatientsundergoingthoracotomyinHandanCentralHospitalfromJune2018toDecember2021wereretrospectivelyselectedanddividedintoPODgroup(n=73,19.31%)andnon-PODgroup(n=305,80.69%)accordingtowhetherornotPODoccurred3daysaftersurgery.TheclinicaldatawereextractedandmultivariatelogisticregressionwasusedtoanalyzetheriskfactorsofPOD,andtheefficacyofrSO2inpredictingPODwasevaluatedbydrawingtheROCcurve.
ResultsUnivariateanalysisshowedthattheproportionofpatientsmorethan75yearsold,withdiabetes,mechanicalventilation,ICUadmissionaftersurgeryandsleepdisorders,andthemaximumpercentageofthedecreasedrSO2comparedtobaselinevalues(rSO2%max)inPODgroupweresignificantlyhigherthanthoseinnon-PODgroup,andthemeanintraoperativerSO2wasstatisticallylowerthanthatinnon-PODgroup(P<0.05).Multivariatelogisticregressionanalysisshowedthatoldage(morethan75yearsold,OR=1.255,P=0.013),preoperativesleepdisorder(OR=1.500,P=0.027)andrSO2%max>22.75%(OR=1.833,P=0.005)weretheindependentriskfactorsforPODinelderlypatientsundergoingthoracotomy.ROCcurveanalysisshowedthatAUCofrSO2%maxinpredictingPODwasthehighest(0.892),followedbyoldage(0.786)andsleepdisorder(0.731).
ConclusionIntraoperativerSO2declineisanindependentriskfactorforPODinelderlypatientsundergoingthoracotomy,andmonitoringrSO2ishelpfulforpredictingtheriskofPODandearlyintervention.
文章编号: 中图分类号:R619 文献标志码:B
基金项目:河北省医学科学研究课题计划(20210382)
Author Name | Affiliation |
WANGJia-zheng,ZHANGDong-ying,CHENHui-xia,ZHANGLei,LIUPan-pan | Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056001, China |
引用文本:
王甲正,张东莹,陈慧霞,张蕾,刘盼盼.老年开胸手术患者术中脑氧饱和度与术后谵妄的相关性[J].中国临床研究,2023,36(1):76-80.
王甲正,张东莹,陈慧霞,张蕾,刘盼盼.老年开胸手术患者术中脑氧饱和度与术后谵妄的相关性[J].中国临床研究,2023,36(1):76-80.