目的 分析饮茶习惯对老年患者术后谵妄（postoperative delirium, POD）的影响因素。 方法 选择青岛大学附属青岛市市立医院择期行腰硬联合麻醉下膝/髋关节置换术的患者254例，依据术前访视情况分为饮茶组与非饮茶组（每组127例）。年龄>65岁，性别不限，体重50~80 kg，ASA分级Ⅰ、Ⅱ级。术前1 d采用简易精神状态检查（Mini‑Mental State Examination, MMSE）量表评估认知状态，术后1~7 d（或出院前）同一时间段于PACU采用意识错乱评估方法（Confusion Assessment Method, CAM）判断是否发生POD。采用ELISA法检测脑脊液中茶多酚、咖啡因的浓度。采用分光光度法检测脑脊液中乙酰胆碱酯酶（acetylcholinesterase, AChE）、丁酰胆碱酯酶（butylcholinesterase, BuChE）的活性。经Logistic回归和受试者工作特征（receiver operator characteristic, ROC）曲线分析饮茶习惯对老年患者POD的影响因素、预防和治疗价值。 结果 饮茶组POD发生率为8.62%，非饮茶组POD发生率为23.08%，POD总发生率为15.88%。Logistic回归分析表明：在调整年龄、性别、体重、手术时长和失血量后，每月饮茶量多［比值比（odds ratio， OR）=0.776，95%CI 0.569~0.847］、饮用绿茶（OR=0.801，95%CI 0.638~0.920）、每月饮用绿茶量多（OR=0.891，95%CI 0.626~0.934）、脑脊液中高浓度咖啡因（OR=0.933，95%CI 0.872~0.999）和茶多酚（校正后OR=0.803，95%CI 0.438~0.820）为POD的保护因素。ROC曲线分析表明：每月饮用绿茶量曲线下面积（area under curve, AUC）为0.843（P<0.001），脑脊液中咖啡因浓度AUC为0.914（P<0.001），茶多酚浓度AUC为0.932（P<0.001），三者对老年患者POD的预防和治疗价值较高。 结论 每月饮用绿茶量多、脑脊液中高浓度咖啡因和茶多酚是老年患者术后谵妄的保护因素，可能与饮茶习惯，尤其是饮用绿茶有关。
Objective To analyze the influencing factors of tea drinking habit on postoperative delirium (POD) in elderly patients. Methods A total of 254 patients who were scheduled for knee/hip replacement under combined spinal‑epidural anesthesia in Qingdao Municipal Hospital Affiliated of Qingdao University were selected. According to their condition before surgery, they were divided into two groups (n=127): a tea drinking group and a non‑tea drinking group. Age>65 years old, male or female, weight 50‒80 kg, American Society of Anesthesiologists (ASA) grade Ⅰ or Ⅱ. The cognitive condition was assessed by the Mini‑Mental State Examination (MMSE) one day before operation, and the presence of POD was evaluated by the Confusion Assessment Method (CAM) on the same period in PACU one to seven days after surgery or before discharge. The concentrations of tea polyphenols and caffeine in cerebrospinal fluid were detected by ELISA. The activities of acetylcholinesterase (AChE) and butylcholinesterase (BuChE) in cerebrospinal fluid were detected by spectrophotometry. Logistic regression and receiver operator characteristic (ROC) curves were used to analyze the influencing factors, prevention and treatment value of tea drinking habit for elderly patients with POD. Results The incidence of POD was 8.62% for the tea drinking group and 23.08% for the non‑tea drinking group, with a total incidence of 15.88%. Logistic regression analysis showed that after adjustment for age, sex, weight, operation time and blood loss, a high amount of tea drinking per month [odds ratio (OR)=0.776, 95%CI 0.569‒0.847], drinking green tea (OR=0.801, 95%CI 0.638‒0.920), a high amount of green tea drinking per month (OR=0.891, 95%CI 0.626‒0.934), and a high concentration of caffeine (OR=0.933, 95%CI 0.872‒0.999) and tea polyphenols (OR=0.803,95%CI 0.438‒0.820) in cerebrospinal fluid were the protective factors of POD. According to area under curve (AUC) analysis, the area under the curve (AUC) of green tea consumption per month was 0.843 (P<0.001). The AUC of caffeine concentration in cerebrospinal fluid was 0.914 (P<0.001), while the AUC of tea polyphenol concentrations was 0.932 (P<0.001), which were useful for the prevention and treatment of POD in elderly patients. Conclusions Drinking high amounts of green tea per month and high concentrations of caffeine and tea polyphenols in cerebrospinal fluid are the protective factors for POD in elderly patients, which may be related to tea drinking habit, especially green tea.
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