Ding Xian, Gao Xiang, Chen Qizhong, Jiang Xuliang, Li Yi, Xu Jingjing, Qin Guowei, Lu Shunmei, Huang Dongxiao
Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Original Department at Wuxi Third People's Hospital), Wuxi, Jiangsu, China.
Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China.
Pain Med. 2021 Feb 4;22(1):15-21. doi: 10.1093/pm/pnaa314.
Studies have provided some evidence that pain is a risk factor for postoperative delirium (POD). Therefore, we investigated the relationship between preoperative pain and POD after noncardiac surgery.
POD was assessed with the Montreal Cognitive Assessment, and preoperative cognition was assessed with the Mini-Mental State Examination. Plasma C-reactive protein (CRP) was detected by enzyme-linked immunosorbent assay before surgery. Preoperative pain was classified by its duration before surgery as chronic pain (lasting more than 1 month), acute pain (lasting less than 1 month), or no pain (no obvious pain). Multiple linear regression was used to adjust for confounding.
From October 15, 2018, through August 12, 2019, a total of 67 patients were randomized; 7 were excluded because they were discharged before the seventh postoperative day. The prevalence of POD was significantly higher in the acute pain group (13 of 20; 65%) than in the chronic pain group (5 of 20; 25%) or the no pain group (6 of 20; 30%) (P = 0.019), indicating that delirium is associated with preoperative acute pain. The plasma level of preoperative CRP was also higher in the acute pain group than in the other two groups (mean [interquartile range]: 10.7 [3.3, 29.3] vs 1 [0.5, 3.8]mg/l; P < 0.001), suggesting that elevated preoperative plasma levels of CRP were associated with delirium.
Preoperative acute pain was associated with POD, and increased plasma levels of CRP provide a marker. In addition, we found that illiteracy and advanced age were risk factors for POD.
研究已提供一些证据表明疼痛是术后谵妄（POD）的一个危险因素。因此，我们调查了非心脏手术后术前疼痛与POD之间的关系。
采用蒙特利尔认知评估量表评估POD，采用简易精神状态检查表评估术前认知功能。术前通过酶联免疫吸附测定法检测血浆C反应蛋白（CRP）。术前疼痛根据手术前的持续时间分为慢性疼痛（持续超过1个月）、急性疼痛（持续少于1个月）或无疼痛（无明显疼痛）。采用多元线性回归调整混杂因素。
从2018年10月15日至2019年8月12日，共67例患者被随机分组；7例因在术后第7天前出院而被排除。急性疼痛组的POD患病率（20例中有13例；65%）显著高于慢性疼痛组（20例中有5例；25%）或无疼痛组（20例中有6例；30%）（P = 0.019），表明谵妄与术前急性疼痛有关。急性疼痛组术前CRP的血浆水平也高于其他两组（均值[四分位间距]：10.7 [3.3, 29.3] vs 1 [0.5, 3.8]mg/l；P < 0.001），提示术前血浆CRP水平升高与谵妄有关。
术前急性疼痛与POD有关，血浆CRP水平升高是一个标志物。此外，我们发现文盲和高龄是POD的危险因素。
