国际麻醉学与复苏杂志   2024, Issue (1): 0-0
    
帕金森病脑深部电刺激植入术患者术后谵妄的危险因素分析
王洁, 马婷婷, 崔倩宇, 王娟, 曾敏, 彭宇明1()
1.首都医科大学附属北京天坛医院
Risk factors of postoperative delirium in patients undergoing deep brain stimulation for Parkinson's disease
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摘要:

目的 探索帕金森病(PD)患者行脑深部电刺激植入术(DBS)术后谵妄(POD)相关危险因素。 方法 前瞻性收集2020年10月至2022年5月择期行DBS的PD患者的术前资料、术中资料、术后资料及POD的发生情况。根据术后是否发生谵妄将患者分为谵妄组(52例)及非谵妄组(155例)。对两组患者资料进行组间比较,并通过logistic回归分析发生POD的危险因素。 结果 共207例患者纳入研究,其中有52例(25.1%)患者发生POD。与非谵妄组比较,谵妄组患者的年龄较大,术前改良Hoehn‑Yahr(H‑Y)分级较高,术后第1天数字分级评分法(NRS)疼痛评分明显较高(均P<0.05)。多因素logistic回归分析显示年龄[校正比值比(OR) 1.09,95%置信区间(CI) 1.03~1.16,P=0.002]、术前改良H‑Y分级(校正OR 2.67,95%CI 1.42~5.00,P=0.002)以及术后第1天NRS疼痛评分(校正OR 1.44,95%CI 1.22~1.70,P<0.001)是DBS POD发生的独立危险因素。 结论 PD患者行DBS后谵妄的发生率为25.1%,年龄、术前改良H‑Y分级以及术后第1天NRS疼痛评分是POD独立危险因素。

关键词: 帕金森病; 脑; 深部电极; 术后谵妄; 危险因素
Abstract:

Objective To explore the risk factors of deep brain stimulation (DBS) for postoperative delirium (POD) in patients with Parkinson's disease (PD). Methods PD patients who underwent selective DBS from October 2020 to May 2022 were prospectively selected and their preoperative data, intraoperative data, postoperative data and the incidence of POD were collected. According to the presence of postoperative delirium, the patients were divided into two groups: a delirium group (n=52) and a non‑delirium group (n=155). Then, both groups were compared for these data and logistic regression analysis was used to detect the risk factors for POD. Results A total of 207 patients were included into the study, among which 52 (25.1%) presented POD. Compared with the non‑delirium group, the delirium group showed increases in age, modified Hoehn‑Yahr (H‑Y) stage before surgery, and significantly Numerical Rating Scale (NRS) score on postoperative day 1 (all P<0.05). Multivariate logistic regression analysis indicated that age [adjusted odd ratio (OR) 1.09 [95% confidence interval (CI) 1.03, 1.16], P=0.002], modified H‑Y stage before surgery [adjusted OR 2.67 (95%CI 1.42, 5.00), P=0.002], and NRS score on postoperative day 1 [adjusted OR 1.44 (95%CI 1.22, 1.70), P<0.001] were the independent risk factors of DBS for POD. Conclusions The incidence of POD after DBS in PD is 25.1%. Age, modified H‑Y stage before surgery, and NRS score on postoperative day 1 are the independent risk factors for POD.

Key words: Parkinson's disease; Brain; Deep electrode; Postoperative delirium; Risk factor