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摘要：
目的 分析老年患者术后谵妄（postoperative delirium, POD）的危险因素，探究术后中性粒细胞与淋巴细胞比率（neutrophil to lymphocyte ratio, NLR）的水平与老年患者POD的关系。 方法 选取2019年3月至2019年8月全身麻醉下接受非心脏手术后的老年患者531例，年龄≥65岁。使用混淆评估法（the Confusion Assessment Method, CAM）每天2次评估术后3ｄ内POD发生情况。根据患者是否发生POD分为术后谵妄组和非术后谵妄组。主要观察POD的发生率，并使用多因素Logistic回归分析评估POD的危险因素。同时使用倾向性评分匹配（Propensity Score Matching, PSM）进一步分析POD的危险因素。 结果 共125例（23.5%）患者发生POD。年龄［比值比（odds ratio, OR）=1.044，95％CI 1.006~1.048，P=0.025）］、查尔森合并症指数（Charlson Comorbidity Index, CCI）（OR=1.189，95％CI 1.031~1.370，P=0.017）、Hb（OR=0.988，95％CI 0.977~0.999，P=0.039）、手术时间（OR=1.003，95％CI 1.000~1.005，P=0.043）、拔管时间（OR=1.028，95％CI 1.012~1.044，P=0.001）、术后入ICU（OR=2.222，95％CI 1.308~3.775，P=0.003）、术后NLR（OR=1.027，95％CI 1.000~1.054，P=0.048）是POD的独立危险因素。文化程度（P=0.061）、出血量（P=0.161）、日常生活活动能力量表（Activities of Daily Living, IADL）（P=0.368）两组间差异无统计学意义（P>0.05）。对术后NLR进行受试者工作特征（receiver operating characteristic curve, ROC）曲线分析，得出POD风险增加的术后NLR拐点值为11.85，将术后NLR转换为二分类变量并代入Logistic多因素回归模型，校正影响因素后，结果显示术后NLR拐点值>11.85者POD的风险明显增加［OR=2.019，95％CI 1.292~3.155，P=0.002］，同时将混杂因素进行PSM后显示，术后NLR水平升高使POD的发生风险增高（OR=1.033，95%CI 1.007~1.060, P=0.012）。 结论 对于非心脏手术后的老年患者，术后NLR水平升高增加POD的发生风险。
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Abstract: Objective To analyze the risk factors of postoperative delirium (POD) in elderly patients and explore the relationship between neutrophil to lymphocyte ratio (NLR) and POD in elderly patients. Methods A total of 531 elderly patients, aged ≥65 years, were enrolled, who underwent non‑cardiac surgery under general anesthesia from March 2019 to August 2019. The occurrence of POD within 3 days after surgery was assessed with the Confusion Assessment Method (CAM), twice per day. According to the presence of POD, the patients were divided into two groups: a POD group and a non‑POD group and the incidences of POD were recorded. Meanwhile, the risk factors for POD were assessed by multivariate logistic regression analysis as well as propensity score matching (PSM). Results PA total of 125 patients (23.5%) presented POD. Age [odds ratio (OR)=1.044, 95% confidence interval (CI) 1.006‒1.048, P=0.025], Charlson Comorbidity Index (CCI)(OR=1.189, 95%CI 1.031‒1.370, P=0.017), hemoglobin (Hb) (OR=0.988, 95%CI 0.977‒0.999, P=0.039), operation time (OR=1.003, 95%CI 1.000‒1.005, P=0.043), extubation time (OR=1.028, 95%CI 1.012‒1.044, P=0.001), admission to ICU (OR=2.222, 95%CI 1.308‒3.775, P=0.003) and postoperative NLR (OR=1.027, 95%CI 1.000‒1.054, P=0.048) were independent risk factors for POD. There were no statistically significant differences in educational level (P=0.061), blood loss (P=0.161), and Activities of Daily Living (IADL) (P=0.368) between the two groups (P>0.05). According to the receiver operating characteristic curve (ROC) of postoperative NLR, the cut‑off value was 11.85 for an increased risk of POD. According to the cut‑off value, postoperative NLR was converted into a binary variable and substituted into the multivariate logistic regression model. After influencing factor correction, the risk of POD significantly increased in patients with postoperative NLR cut‑off point value>11.85 (OR=2.019, 95%CI 1.292‒3.155, P=0.002). Meanwhile, the PSM of confounding factors showed that an increase in postoperative NLR level increased the risk of POD (OR=1.033, 95%CI 1.007‒1.060, P=0.012). Conclusions Increased postoperative NLR increases the risk of POD in elderly patients with noncardiac surgery.
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