摘要目的 分析老年结直肠癌患者发生术后谵妄(POD)与非POD的临床结局以及相关影响因素.方法 回顾性分析2013年1月至2018年3月接受手术的268例老年(≥60岁)结直肠癌患者的临床资料,以意识模糊评估量表筛查患者是否出现POD,并分为谵妄组、非谵妄组,对两组并发症、术后住院天数、术后30 d病死率情况进行统计学分析;同时对发生POD的相关影响因素采用Logistic回归进行多因素统计分析.结果 结直肠癌患者发生POD共32例(11.9%),术后3 d内出现比例最高,占78.1%(25/32).谵妄组术后并发症发生率较非谵妄组明显增高[31.2% (10/32)比17.4%(41/236),P＝0.031],术后住院天数明显延长[(14.2 ± 1.6)d比(9.3 ± 1.8)d,P＝0.010],术后30 d病死率亦增加[6.2%(2/32)比1.7%(4/236),P＝0.045].单因素分析中,性别、年龄、合并症指数评分、美国麻醉医师协会(ASA)分级、精神病史、脑血管病史、酗酒史、术前白蛋白、围手术期输血、术后转ICU者均是导致POD的相关因素(P均＜0.05),其中高龄(OR＝1.072,95% CI 1.012~1.145)、精神病史(OR＝9.806,95% CI 2.748~25.107)、围手术期输血(OR＝2.466,95% CI 1.126~7.441)是发生POD独立的影响因素(P均＜0.05).结论 老年结直肠癌患者发生POD比例较高,且与未发生POD患者相比并发症发生率、病死率均较高;针对高龄、有精神病史、有围手术期输血史的POD高危患者应积极进行干预.

abstractsObjective To compare the clinical outcomes between postoperative delirium(POD) and non- POD elderly patients with colorectal cancer and analysis of related factors. Methods Consecutive 268 elderly patients with colorectal cancer from January 2013 to March 2018 were retrospectively analyzed. These patients were evaluated daily after surgery for 7 d by confusion assessment method and were divided into delirium group and non-delirium group. Clinical outcomes were compared between the two groups, including postoperative complications, length of hospital stay, and mortality within 30 d. Logistic regression analysis was used to identify independent predictors of POD. Results Thirty-two patients (11.9% ) developed in POD, and 78.1% (25/32) POD patients were diagnosed within 3 d after surgery. Patients in delirium group had more complications [31.2%(10/32) vs. 17.4%(41/236), P＝0.031], longer postoperative hospital stay [(14.2 ± 1.6) d vs. (9.3 ± 1.8) d, P＝0.010] and higher mortality within 30 d [6.2% (2/32) vs. 1.7% (4/236), P＝0.045]. Univariate analysis revealed that advanced age, male, higher Charlson comorbidity index, higher American Society of Anesthesiologists Classification, history of psychiatric disease, history of cerebrovascular disease, alcohol abuse, lower preoperative blood albumin concentration, perioperative blood transfusion and postoperative transform to intensive care unit were significantly related to the development of POD (P＜0.05). Logistic regression analysis identified that advanced age ( OR＝1.072, 95% CI 1.012- 1.145), history of psychiatric disease ( OR＝9.806, 95% CI 2.748-25.107) and perioperative blood transfusion ( OR＝2.466, 95% CI 1.126-7.441) were independent risk factors of POD. Conclusions POD is relatively common in elderly patients undergoing colorectal cancer surgery. The high morbidity of postoperative complication and mortality is associated with POD. Comprehensively preventive strategies should be carried out for high-risk patients of advanced age, history of psychiatric disease, and perioperative blood transfusion.