基于老年患者的围手术期临床特征预测全麻术后认知功能障碍发生风险的分析

Analysis of prediction of risk of cognitive dysfunction after general anesthesia based on perioperative clinical characteristics in elderly patients

中文关键词: 老年  认知功能障碍  全麻  术后感染  MoCA评分  年龄  术后镇痛

英文关键词: elderly  cognitive dysfunction  general anesthesia  postoperative infection  MoCA score  age  postopera-tive analgesia

中文摘要:

      目的 筛选老年患者全麻术后发生认知功能障碍的危险因子,并建立危险评分计算公式,评估其预测效能.方法 回顾性选择2021年01月-2023年10月在海安市人民医院行全麻手术的老年患者321例,采用蒙特利尔认知评估量表(MoCA)进行认知评估,将患者分为认知功能障碍组(POCD组,n=107)和认知功能正常组(无POCD组,n=214).收集老年患者的临床资料,采用单因素Logistic回归方法分析筛选危险因素及保护因素,采用多因素Logistic回归方法分析并筛选独立危险因素,使用受试者工作特征曲线(ROC)评估独立危险因素对老年患者全麻术后发生认知功能障碍的预测效能.结果 年龄增加、有高血压病史、有糖尿病病史、麻醉时间延长、术后感染发生为老年患者全麻术后认知功能障碍的危险因素,术后镇痛为老年患者全麻术后认知功能障碍的保护因素.年龄、术后感染为老年患者术后认知功能障碍的独立危险因素,术后镇痛为独立保护因素.危险评分=1.15+0.54 ×年龄+0.25 ×术后镇痛+0.12 ×术后感染.ROC曲线表明,年龄、术后镇痛、术后感染及危险评分曲线下面积诊断分别为0.72(P=0.004)、0.63(P=0.041)、0.57(P=0.038)、0.81(P=0.002).结论 年龄增加、术后感染可能为老年患者术后认知功能障碍的独立危险因素,而术后镇痛是其保护因素;危险评分对老年患者术后认知功能障碍可能有较好的预测效能.

英文摘要:

      Objective To identify risk factors for postoperative cognitive dysfunction(POCD)in elderly patients after general anesthesia and establish a risk score calculation formula to evaluate its predictive efficacy.Methods A retrospective study was conducted on 321 elderly patients who underwent general anesthesia in People's Hospital of Hai'an City from January 2021 to October 2023.Their cognitive function was assessed by the Montreal Cognitive Assessment(MoCA)scale,and then they were divided into cognitive dysfunction group(POCD group,n=107)and normal cognitive function group(non-POCD group,n=214).Their clinical data were collected.Univariate Logistic regression was used to screen risk factors and protective factors.Multivariate Logistic regression was used to identify independent risk factors.Receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of these factors for POCD.Results Increased age,hypertension histo-ry,diabetes history,prolonged anesthesia duration and postoperative infection were identified as risk factors for POCD,while postoperative analgesia served as a protective factor.Age and postoperative infection were independent risk factors for POCD,and postoperative analgesia was an independent protective factor.The risk score calculation formula was defined as:Risk score=1.15+0.54 × age-0.25 × postoperative analgesia+0.12 × postoperative infection.ROC curve analysis showed that the area under the curve of age,postoperative analgesia,postoperative infection and risk score were 0.72(P=0.004),0.63(P=0.041),0.57(P=0.038)and 0.81(P=0.002),respectively.Conclusion Increased age and postoperative infection are independent risk factors for POCD in elderly patients,while postoperative analgesia is a protective factor.Risk scores may have good predictive efficacy for POCD in elderly patients.