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退行性颈椎脊髓病患者术后谵妄的发生率及危险因素分析

Analysis of the Incidence and Risk Factors of Postoperative Delirium in Patients With Degenerative Cervical Myelopathy.

作者信息

Kim Namhoo, Kim Tae-Hwan, Oh Jae Keun, Lim Jeongsup, Lee Kang Uk, Kim Seok Woo

机构信息

Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

出版信息

Neurospine. 2022 Jun;19(2):323-333. doi: 10.14245/ns.2142778.389. Epub 2022 May 12.

Abstract

OBJECTIVE

The purpose of this study is to analyze various risk factors that can cause postoperative delirium (POD) in degenerative cervical myelopathy (DCM) patients, which may affect normal recovery and outcomes after surgery, and to help deal with them in advance and to take a medical approach.

METHODS

A total of 148 patients aged 60 years or older who underwent laminoplasty or anterior cervical discectomy and fusion (ACDF) for DCM from 2008 to 2015 were included in this study. Incidence and multiple risk factors for development of POD were analyzed.

RESULTS

POD occurred in 24 patients (16.2%). Among the 148 patients, 78 received laminoplasty, of whom 19 patients (24%) experienced delirium; the other 70 patients underwent ACDF, of whom 5 patients (7.1%) experienced delirium. History of Parkinson disease (odds ratio [OR], 178.242; p = 0.015), potassium level (OR, 3.764; p = 0.031), and surgical approach of laminoplasty over ACDF (OR, 8.538; p = 0.008) were found to be significant risk factors in a multivariate analysis. Age (OR, 1.056; p = 0.04) and potassium level (OR, 3.217; p = 0.04) were significant risk factors in the laminoplasty group.

CONCLUSION

The findings of this study suggest that the incidence and risk factors for POD may vary in patients with DCM. It is necessary to understand multiple factors that affect the development of POD.

摘要

目的

本研究旨在分析可导致退行性颈椎病(DCM)患者术后谵妄(POD)的各种风险因素,这些因素可能影响手术后的正常恢复和结果,并提前做好应对措施并采取医学手段。

方法

本研究纳入了2008年至2015年期间因DCM接受椎板成形术或颈椎前路椎间盘切除融合术(ACDF)的148例60岁及以上患者。分析了POD的发生率和多种危险因素。

结果

24例患者(16.2%)发生了POD。在148例患者中,78例行椎板成形术,其中19例(24%)发生谵妄;另外70例行ACDF,其中5例(7.1%)发生谵妄。多因素分析发现帕金森病病史(优势比[OR],178.242;p = 0.015)、血钾水平(OR,3.764;p = 0.031)以及椎板成形术与ACDF相比的手术方式(OR,8.538;p = 0.008)是显著的危险因素。在椎板成形术组中,年龄(OR,1.056;p = 0.04)和血钾水平(OR,3.217;p = 0.04)是显著的危险因素。

结论

本研究结果表明,DCM患者中POD的发生率和危险因素可能存在差异。有必要了解影响POD发生的多种因素。

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本文引用的文献

1
Identifying delirium in Parkinson disease: A pilot study.识别帕金森病中的谵妄:一项试点研究。
Int J Geriatr Psychiatry. 2020 May;35(5):547-552. doi: 10.1002/gps.5270. Epub 2020 Feb 7.
2
Delirium Superimposed Upon Dementia.
J Am Med Dir Assoc. 2019 Nov;20(11):1382-1383. doi: 10.1016/j.jamda.2019.09.019.
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2-F-fluoro-2-deoxyglucose positron emission tomography in delirium.2-F-氟-2-脱氧葡萄糖正电子发射断层扫描在谵妄中的应用
J Cereb Blood Flow Metab. 2017 Nov;37(11):3556-3567. doi: 10.1177/0271678X17701764. Epub 2017 Mar 28.

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