老年结直肠癌患者术后谵妄的危险因素。
Risk factors for postoperative delirium in elderly patients with colorectal cancer.
机构信息
Department of Surgery, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan.
出版信息
Surg Endosc. 2010 Sep;24(9):2135-9. doi: 10.1007/s00464-010-0911-7. Epub 2010 Feb 23.
AIMS
The aim of this retrospective study is to examine risk factors for postoperative delirium in elderly patients with colorectal cancer.
METHODS
The study subjects were patients aged 71 years and older who underwent open surgery (OS) or laparoscopically assisted surgery (LAS) for colorectal cancer from January 2004 to December 2007. Preoperative evaluation, operative factors, morbidity, and mortality were analyzed using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Prognostic Nutritional Index (PNI). Delirium was diagnosed by the Confusion Assessment Method (CAM).
RESULTS
Postoperative delirium was diagnosed in 10.9% of elderly patients with colorectal cancer. Age, American Society of Anesthesiologists (ASA) score, and PNI were significantly higher in patients with delirium than those without (P < 0.05, each). Postoperative delirium occurred more frequently in patients with encephalopathy than in those without (P = 0.003). Logistic regression analysis identified PNI and encephalopathy as two independent risk factors for postoperative delirium.
CONCLUSIONS
Preoperative evaluation of nutritional status is important in elderly patients with colorectal cancer in order to prevent postoperative delirium.
目的
本回顾性研究旨在探讨老年结直肠癌患者术后谵妄的危险因素。
方法
本研究对象为 2004 年 1 月至 2007 年 12 月期间接受开腹手术（OS）或腹腔镜辅助手术（LAS）治疗的 71 岁及以上结直肠癌患者。采用生理和手术严重程度评分用于死亡率和发病率评估（POSSUM）和预后营养指数（PNI）对术前评估、手术因素、发病率和死亡率进行分析。采用意识模糊评估方法（CAM）诊断谵妄。
结果
老年结直肠癌患者术后谵妄的发生率为 10.9%。患有谵妄的患者的年龄、美国麻醉师协会（ASA）评分和 PNI 显著高于无谵妄的患者（P<0.05，均）。患有脑病的患者术后谵妄的发生率高于无脑病的患者（P=0.003）。Logistic 回归分析确定 PNI 和脑病是术后谵妄的两个独立危险因素。
结论
对于老年结直肠癌患者，术前进行营养状况评估对于预防术后谵妄非常重要。
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