术前血浆纤维蛋白原与老年骨科手术病人术后谵妄的相关性研究

doi:10.3969/j.issn.1003-9198.2024.12.007

Abstract

Abstract: Objective To explore the correlation between preoperative plasma fibrinogen and postoperative delirium (POD) in the elderly patients undergoing orthopedic surgery, and to explore the predictive value of preoperative plasma fibrinogen for POD. Methods A total of 440 elderly patients undergoing orthopedic surgery at the Second Affiliated Hospital of Nanjing Medical University from February 2021 to August 2023 were enrolled in this study. The clinical data were collected. According to the occurrence of POD, the patients were divided into POD group and Non-POD group. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the correlation between preoperative plasma fibrinogen and POD and the predictive value of preoperative plasma fibrinogen for POD in the elderly patients undergoing orthopedic surgery. Results There were 74(16.82%) cases presenting with POD in this study. Compared with Non-POD group, the levels of age,American Society of Anesthesiologists (ASA) classification, surgical history,intraoperative blood loss, white blood cells, C-reactive protein, fibrinogen, creatinine and prothrombin time were significantly higher, while the levels of body mass index(BMI), preoperative Mini-Mental State Examination (MMSE) score,hemoglobin and albumin were significantly lower in POD group (P<0.05). Logistic regression analysis showed that ASA grade(OR=3.839, 95%CI: 1.613－9.140, P=0.002), preoperative MMSE (OR=0.895, 95%CI: 0.839－0.955, P=0.001), age (OR=1.098, 95%CI: 1.041－1.159, P=0.001) and fibrinogen (OR=1.695, 95%CI: 1.117－2.573, P=0.013) were the independent influencing factors of POD. ROC curve showed that the area under the curve(AUC)of age, preoperative MMSE, fibrinogen, and ASA classification predicting POD was 0.819(0.762-0.875), 0.779(0.713-0.846), 0.737(0.671-0.803), and 0.760(0.707-0.814), respectively. The AUC of the combination of four indicators in predicting POD was 0.889(0.848-0.930), with a sensitivity of 82.40% and a specificity of 82.00%. Conclusions Preoperative plasma fibrinogen is significantly increased in the elderly patients presenting with POD, which can be used as a predictive marker for POD.

Key words: fibrinogen, aged, orthopedic surgery, postoperative delirium

CLC Number:

R 687.3

LIU Quanfang, DUAN Huawei, HU Xiaoyi, JI Muhuo, FAN Di. Correlation between preoperative plasma fibrinogen and postoperative delirium in elderly patients undergoing orthopedic surgery[J]. Practical Geriatrics, 2024, 38(12): 1220-1223.

References

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Correlation between preoperative plasma fibrinogen and postoperative delirium in elderly patients undergoing orthopedic surgery

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