围手术期C反应蛋白动态变化与老年非心脏手术患者术后谵妄发生风险的相关性分析

doi:10.3969/j.issn.1003-9198.2026.06.014

摘要/Abstract

摘要： 目的探讨围手术期C反应蛋白动态变化(ΔCRP)与术后谵妄(POD)的相关性,并探讨其对POD的预测价值。方法选取2021年2月至2025年7月在南京医科大学第二附属医院行择期全麻手术的老年患者574例,根据是否发生POD分为POD组(118例)与无POD(N-POD)组(456例)。根据术前访视和电子病历系统收集患者的基线资料以及实验室检查结果,记录患者术前1 d的CRP水平以及术后3 d内的CRP最高值,并计算ΔCRP。分析围手术期ΔCRP与POD的相关性,及其对POD的预测价值。结果本研究中有118例患者发生POD。POD组城市人口比例、文化程度、术前MMSE评分、红细胞、血红蛋白、白蛋白、ALT、肌酸激酶水平明显低于N-POD组,而ASA分级、术中失血量、术中总入量、手术时间、凝血酶原时间、纤维蛋白原、D-二聚体、术前CRP、术后最高CRP、ΔCRP水平明显高于N-POD组(P＜0.05)。多因素logistic回归分析显示,ΔCRP与POD的关联强度显著(每增加1 mg/L:OR=1.013,95%CI:1.008~1.018;每增加10 mg/L:OR=1.136,95%CI:1.079~1.196)。将ΔCRP按四分位数分组,以Q1组为参照,Q4 组POD发生风险显著升高(OR=5.078,95%CI: 2.332～11.059)。ΔCRP预测POD的AUC为0.788(95%CI:0.746～0.830)。结论围术期ΔCRP与POD发生风险呈显著的剂量依赖性正相关,是POD发生的独立危险因素。

关键词: C反应蛋白, 全身麻醉, 术后谵妄, C反应蛋白动态变化, 老年人

Abstract: Objective To investigate the correlation between perioperative dynamic change of C-reactive protein (ΔCRP) and postoperative delirium (POD), and to evaluate its predictive value for POD. Methods A total of 574 elderly patients undergoing elective general anesthesia at the Second Affiliated Hospital of Nanjing Medical University from February 2021 to July 2025 were enrolled and divided into a POD group (n=118) and a non-POD (N-POD) group (n=456) based on the occurrence of POD. Baseline data and laboratory test results were collected, and the CRP levels one day before surgery and the highest CRP value within three days after surgery were recorded to calculate ΔCRP. The correlation of ΔCRP level with POD was analyzed and the predictive value of ΔCRP level for POD was assessed. Results POD occurred in 118 patients. Compared with N-POD group, the proportion of urban residents, educational level, preoperative mini-mental state examination (MMSE) scores, the levels of red blood cells, hemoglobin, albumin, alanine aminotransferase, and creatine kinase were significantly lower, while American Society of Anesthesiologists (ASA) classification, intraoperative blood loss, total intraoperative fluid input, operation time, and the levels of prothrombin time, fibrinogen, D-dimer, preoperative CRP, postoperative CRP, and ΔCRP were significantly higher in POD group (P<0.05). Multivariable logistic regression analysis showed significant association between ΔCRP and POD (increased by 1 mg/L: OR=1.013, 95%CI: 1.008－1.018; increased by 10 mg/L: OR=1.136, 95%CI: 1.079－1.196). The patients were divided into 4 groups according to quartile of ΔCRP, and the risk of POD in Q4 group was significantly increased (OR=5.078, 95%CI: 2.332－11.059). The AUC of ΔCRP for predicting POD was 0.788 (95%CI: 0.746－0.830). Conclusions Perioperative ΔCRP exhibits a significant dose-dependent positive correlation with the risk of POD and is an independent risk factor for POD occurrence.

Key words: C-reactive protein, general anesthesia, postoperative delirium, dynamic change of C-reactive protein, aged

中图分类号:

R 619

刘昱廷, 柳雯, 纪木火. 围手术期C反应蛋白动态变化与老年非心脏手术患者术后谵妄发生风险的相关性分析[J]. 实用老年医学, 2026, 40(6): 613-618.

LIU Yuting, LIU Wen, JI Muhuo. Correlation between perioperative dynamic change of C-reactive protein and the risk of postoperative delirium in elderly patients undergoing non-cardiac surgery[J]. Practical Geriatrics, 2026, 40(6): 613-618.

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