老年患者术前焦虑与术后谵妄的相关性研究

发布时间：2018-12-11 20:35

【摘要】：目的：围手术期全身麻醉手术，，术前及术后随访，观察在老年病人中首次手术病人与多次手术病人术前焦虑程度的差异及术前焦虑与术后谵妄发生率的相关性；探讨改善老年病人术前焦虑和减少术后谵妄发生的可行方法。方法：选择122例患者接受全身麻醉骨科，妇科、普外科手术患者中，性别不限，年龄超过65岁，体重指数小于25， ASA分级1-2级。所有患者按照首次手术或多次手术进入不同的研究队列。组1为首次手术，组2为多次手术。术前一日于病房内进行术前访视,术前焦虑问卷评分。术后第一天和第二天进行术后随访，对所有患者进行术后谵妄的测试。麻醉前静脉注射阿托品0.3mg。应用依托咪酯0.3mg/kg，舒芬太尼0.4ug/kg，咪达唑仑0.5mg/kg，顺式苯磺酸阿曲库铵0.15mg/kg静脉迅速诱导，手术过程中使用异丙酚和瑞芬太尼维持麻醉，用量分别为4-6mg/kg*h和0.5-1ug/kg*min，间断注射苯磺酸阿曲库铵。监测脑电双频指数（BIS）保持在40-60之间。在手术结束即刻、手术结束后6小时后、手术结束24小时后、手术结束48小时后，对所有患者进行谵妄评估的测试，依据评估结果对患者进行是否发生术后谵妄的判断，如果发生谵妄则每日随访至恢复或出院。结果：共122例患者参与本研究，其中组1有62例，组2有60例。两组患者的一般情况无显著差异。各组中各手术类型比较无显著差异。组1患者，有26例发生术前焦虑的发生率为42%，有14例发生术后谵妄，术前焦虑的病人中术后谵妄的发病危险是不存在术前焦虑的病人的1.726倍（RR值等于1.726）总体相对危险度的95%的可信区间为（1.023-2.203）。组2患者，有18例发生术前焦虑的发生率为30%，有8例发生术后谵妄，术后谵妄的发生率为13%。存在术前焦虑的病人中术后谵妄的发病危险是不存在术前焦虑的病人的2.312倍。（RR值等于2.312），总体相对危险度的95%的可信区间为（1.512-4.361）。结论：老年择期全身麻醉的患者中，首次手术和多次手术的患者术前焦虑程度是不同的，与既往有手术麻醉史的病人相比，首次接受麻醉手术的病人的术前焦虑程度更高。术前焦虑是术后谵妄的发病危险因素，首次手术的患者，术前焦虑的病人术后谵妄的发病危险是普通患者的1.726倍，（相对危险度RR值等于1.726）；多次手术的患者，术前焦虑的病人术后谵妄的发病危险是普通患者的2.312倍，（相对危险度RR值等于2.312）。通过耐心细致的术前访视，减轻患者的术前焦虑可能降低术后谵妄的发生，提高麻醉质量，改善患者预后。
[Abstract]:Objective: to observe the degree of preoperative anxiety and the correlation between preoperative anxiety and postoperative delirium in elderly patients during perioperative general anesthesia, preoperative and postoperative follow-up. To explore the feasible methods to improve anxiety and reduce postoperative delirium in elderly patients. Methods: one hundred and twenty-two patients undergoing general anesthesia orthopaedics gynecology and general surgery were selected. The patients were of no gender age over 65 years old body mass index (BMI) less than 25 and ASA grade 1-2. All patients were enrolled in different study cohorts according to first or multiple operations. Group 1 was operated on for the first time and group 2 for multiple operations. The preoperative interview was conducted in the ward on the first day before operation, and the preoperative anxiety questionnaire was scored. All patients were followed up on the first and second day after operation for postoperative delirium testing. Atropine was injected intravenously at 0.3 mg before anesthesia. Etomidate 0.3 mg / kg, sufentanil 0.4 mg / kg, midazolam 0.5 mg / kg, cisbenzenesulfonic acid atracurium 0.15mg/kg were used for intravenous induction, propofol and remifentanil were used to maintain anesthesia during the operation. The dosage was 4-6mg/kg*h and 0.5-1 ugr / kg 路min, respectively, with intermittent injection of atracurium benzenesulfonate. The bispectral index (BIS) of EEG was kept between 40 and 60. Immediately after surgery, 6 hours after surgery, 24 hours after surgery, 48 hours after surgery, all patients were tested for delirium evaluation, and the results were used to judge whether postoperative delirium occurred. If delirium occurs, follow up daily until recovery or discharge. Results: a total of 122 patients participated in this study, including 62 cases in group 1 and 60 cases in group 2. There was no significant difference in general conditions between the two groups. There was no significant difference in the types of operation in each group. In group 1, there were 26 cases of preoperative anxiety and 14 cases of postoperative delirium. The risk of postoperative delirium in patients with preoperative anxiety was 1.726 times (RR = 1.726) and 95% of the total relative risk (1.023-2.203). In group 2, there were 18 cases of preoperative anxiety, 8 cases of postoperative delirium and 13 cases of postoperative delirium. The risk of postoperative delirium in patients with preoperative anxiety was 2.312 times that of patients without preoperative anxiety (. (RR = 2.312), and the confidence interval of 95% of the total relative risk was (1.512-4.361). Conclusion: among the elderly patients undergoing elective general anesthesia, the degree of preoperative anxiety is different between the first operation and the multiple operation. Compared with the patients with previous history of anesthesia, the preoperative anxiety of the patients undergoing the first anesthesia is higher than that of the patients with previous anesthesia. Preoperative anxiety was the risk factor of postoperative delirium. The risk of postoperative delirium was 1.726 times higher in patients with preoperative anxiety than in common patients (RR = 1.726). The risk of postoperative delirium in patients with multiple surgeries was 2.312 times higher than that in normal patients (RR = 2.312). By patient and meticulous preoperative visit, reducing preoperative anxiety may reduce postoperative delirium, improve anaesthesia quality and improve prognosis of patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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