腹腔镜下子宫切除术老年贫血病人发生术后谵妄的影响因素分析

doi:10.3969/j.issn.1003-9198.2022.07.013

摘要/Abstract

摘要： 目的探究行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人术后谵妄(POD)的发生情况及其影响因素。方法选取2019年1月至2021年5月于我院全麻下行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人297例为研究对象,观察术后7 d内病人POD的发生情况,并分析其影响因素。结果 297例病人中,76例发生了POD,POD的发生率为25.59%。多因素Logistic回归分析结果提示:年龄≥70岁、静吸复合麻醉、术前血红蛋白为70~89 g/L、二氧化碳(CO₂)气腹时间>90 min、术中未应用右美托咪定、术后6 h SpO₂≤95%以及术后VAS评分>3分是术前血红蛋白为70~110 g/L的老年病人行腹腔镜下子宫切除术后发生POD的独立危险因素。结论全麻下行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人的POD发生率较高,其与病人的年龄、麻醉方式、术前血红蛋白水平、术中CO₂气腹时间、术后SpO₂、术后疼痛情况及术中是否应用右美托咪定等关系密切。

关键词: 贫血, 腹腔镜下子宫切除术, 术后谵妄, 影响因素, 老年人

Abstract: Objective To investigate the incidence and the influencing factors of postoperative delirium (POD) in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy. Methods A total of 297 elderly patients with preoperative hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia in our hospital from January 2019 to May 2021 were enrolled. The incidence of POD in the patients within 7 days after operation was observed and its influencing factors were analyzed. Results Among the 297 patients, 76 patients presented with POD after operation, and the incidence rate of POD was 25.59%. Multivariate Logistic regression analysis showed that aged ≥70 years old, combined intravenous and inhaled anesthesia, preoperative hemoglobin ranging 70-89 g/L, carbon dioxide (CO₂) pneumoperitoneum time > 90 min, no application of dexmedetomidine during operation, oxygen saturation (SpO₂) ≤ 95% within 6 hours after operation and postoperative visual analogue score (VAS) > 3 were the independent risk factors of POD in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy. Conclusions The incidence of POD in the elderly patients with hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia is high, which is closely related to the patient's age, anesthesia mode, preoperative hemoglobin level, intraoperative CO₂ pneumoperitoneum time, postoperative SpO₂, postoperative pain and intraoperative use of dexmedetomidine.

Key words: anemia, laparoscopic hysterectomy, post-operative delirium, influencing factor, aged

中图分类号:

R556.1

纪玮玮, 刘伟, 饶丽华, 苗民, 陈斌, 胡北. 腹腔镜下子宫切除术老年贫血病人发生术后谵妄的影响因素分析[J]. 实用老年医学, 2022, 36(7): 702-705.

JI Wei-wei, LIU Wei, RAO Li-hua, MIAO Min, CHEN Bin, HU Bei. Analysis of influencing factors of postoperative delirium in elderly patients with anemia after laparoscopic hysterectomy[J]. Practical Geriatrics, 2022, 36(7): 702-705.

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