摘要
目的探讨老年患者膝关节置换术中血糖变异指数(GLUCV)与术后谵妄(POD)的相关性。方法回顾性分析择期行膝关节置换术的老年患者112例,男16例,女96例,年龄65~80岁,BMI 22.0~28.0 kg/m^(2),ASAⅠ或Ⅱ级。根据术后5 d内是否发生POD将患者分为两组:POD组和非POD组。收集术前最后1次简易智力状态检查量表(MMSE)得分、手术时间、术中局部脑氧饱和度(rScO_(2))值降低幅度超过rScO_(2)基础值13%(ΔrScO_(2)>13%)的时间,术前血红蛋白(Hb)、C反应蛋白(CRP)浓度,入室前、麻醉诱导前、麻醉诱导后5 min、切皮后1 min、离室前采集指尖血糖浓度等资料,计算GLUCV。采用单因素和多因素Logistic回归分析老年膝关节置换术患者POD的危险因素,并计算比值比(OR)和95%可信区间(CI)。绘制受试者工作特征(ROC)曲线,通过计算曲线下面积(AUC)分析GLUCV的预测价值。结果术后5 d内发生POD 30例(26.8%)。与非POD组比较,POD组手术时间和术中ΔrScO_(2)>13%时间明显延长(P<0.05),CRP浓度、GLUCV明显升高(P<0.05)。多因素Logistic回归分析显示,术中ΔrScO_(2)>13%时间延长(OR=3.542,95%CI 1.380~9.093,P=0.011)、CRP浓度升高(OR=1.984,95%CI 1.078~3.650,P=0.015)、GLUCV升高(OR=5.257,95%CI 1.690~16.353,P=0.008)是老年膝关节置换术患者发生POD的危险因素。GLUCV预测老年膝关节置换术患者POD的AUC为0.747(95%CI 0.650~0.844,P<0.001),临界值为23.4%,敏感性为71.4%,特异性为63.3%。结论老年患者膝关节置换术GLUCV与POD存在明显相关性,同时GLUCV对于老年患者膝关节置换术发生POD具有良好的预测效能。
Objective To investigate the correlation between blood glucose variability index(GLU CV)and postoperative delirium(POD)in elderly patients undergoing knee arthroplasty.Methods A total of 112 elderly patients undergoing elective knee arthroplasty were analyzed retrospectively,16 males and 96 females,aged 65-80 years,BMI 22.0-28.0 kg/m^(2),ASA physical statusⅠorⅡ.They were divided into two groups according to whether they had POD within 5 days after operation:POD group and non-POD group.The score of the last preoperative mini-mental state examination(MMSE),operation time,the duration of the intraoperative regional cerebral oxygen saturation(rScO_(2))value decreased by more than 13%of the rScO_(2)basic value(ΔrScO_(2)>13%),the preoperative hemoglobin(Hb)and C-reactive protein(CRP)concentration,the fingertip blood glucose concentration before entry,before anesthesia induction,5 minutes after anesthesia induction,1 minute after skin incision,and before leaving the chamber were collected,and the GLU CV was calculated.The risk factors of POD in elderly patients undergoing knee arthroplasty were analyzed by univariate and multivariate logistic regression,and the odds ratio(OR)and 95%confidence interval(CI)were calculated.The receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve(AUC)and analyze the predictive value of GLU CV.Results Thirty patients(26.8%)showed POD symptoms within 5 days after surgery.Compared with the non-POD group,the operation time and duration of intraoperativeΔrScO_(2)>13%in the POD group were significantly prolonged(P<0.05),the CRP concentration and GLU CV were significantly increased(P<0.05).Multivariate logistic regression analysis showed that prolonged time ofΔrScO_(2)>13%(OR=3.542,95%CI 1.380-9.093,P=0.011),elevated CRP concentration(OR=1.984,95%CI 1.078-3.650,P=0.015),and elevated GLU CV(OR=5.257,95%CI 1.690-16.353,P=0.008)were risk factors of POD in elderly patients undergoing knee arthroplasty.ROC curve analysis showed that the area under the AUC of GLU CV in predicting POD in elderly patients undergoing knee arthroplasty was 0.747(95%CI 0.650-0.844,P<0.001),while the optimal cutoff value was 23.4%,the sensitivity was 71.4%,and the specificity was 63.3%.Conclusion GLU CV is closely related to POD,and GLU CV level has a good predictive effect on POD in elderly patients undergoing knee arthroplasty.
作者
潘鑫
蔡宁
李慧慧
官双双
汪辰宇
PAN Xin;CAI Ning;LI Huihui;GUAN Shuangshuang;WANG Chenyu(Department of Anesthesiology,Fuyang People's Hospital,Fuyang 236000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2024年第10期1058-1062,共5页
Journal of Clinical Anesthesiology
基金
安徽省重点研究与开发计划项目(201904a07020026)。
关键词
膝关节置换术
术后谵妄
血糖变异指数
危险因素
血糖
Knee arthroplasty
Postoperative delirium
Blood glucose variability index
Risk factors
Blood glucose
