Analysis of risk factors of cognitive dysfunction after senile vertebral compression fracture surgery
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摘要:
目的 分析老年椎体压缩性骨折患者发生术后认知功能障碍(POCD)的影响因素，为临床制定预防策略提供参考。 方法 选择2018年1月—2022年12月温州市中西医结合医院进行手术治疗的167例骨质疏松椎体压缩性骨折老年患者，收集患者临床资料，采用单因素与多因素logistic回归分析研究老年椎体压缩性骨折患者术后认知功能障碍的危险因素。 结果 167例患者中39例发生术后认知功能障碍，发生率为23.35%。单因素分析显示，术后发生认知功能障碍与未发生认知功能障碍患者的年龄、饮酒史、术后是否感染、围手术期是否镇痛、术后是否有其他并发症、麻醉方式、手术时间、术中额叶平均脑氧饱和度、术前焦虑评分等比较差异有统计学意义(均P＜0.05)。Logistic回归分析显示，年龄≥65岁(OR=3.347，P=0.007)、术后镇痛(OR=2.286，P=0.043)、全身麻醉(OR=3.920，P=0.005)、手术时间≥120 min(OR=3.418，P＜0.001)是患者发生术后认知功能障碍的独立危险因素。 结论 年龄大、术后镇痛、麻醉方式为全身麻醉、手术时间较长是骨质疏松椎体压缩性骨折老年患者发生术后认知功能障碍的危险因素，可有针对性地进行早期临床干预，防治老年患者术后认知功能障碍。 Abstract:Objective To analyze the influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients with vertebral compression fractures, and to provide a reference for clinical prevention strategies. Methods A total of 167 elderly patients with osteoporotic vertebral compression fractures, who underwent surgical treatment at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to December 2022 were selected. The clinical data of the patients were collected. Univariate and multivariate logistic regression analysis were used to investigate the risk factors for postoperative cognitive dysfunction in elderly patients with vertebral compression fractures. Results Among 167 patients, 39 patients developed postoperative cognitive dysfunction, with an incidence of 23.35%. Univariate analysis showed that there were significant differences in age, history of alcohol consumption, postoperative infection, perioperative analgesia, postoperative complications, type of anesthesia, operation time, intraoperative mean frontal lobe oxygen saturation, and preoperative anxiety score between patients with and without postoperative cognitive dysfunction (all P < 0.05). Logistic regression analysis showed that age≥65 years (OR=3.347, P=0.007), postoperative analgesia (OR=2.286, P=0.043), general anesthesia (OR=3.920, P=0.005), operation time ≥120 min (OR=3.418, P < 0.001) were the independent risk factors for postoperative cognitive dysfunction. Conclusion Older age, postoperative analgesia, general anesthesia and longer operation time are risk factors for postoperative cognitive dysfunction in elderly patients with osteoporotic vertebral compression fractures. Targeted early clinical intervention can be used to prevent and treat postoperative cognitive dysfunction in elderly patients. -
Key words:
- Compression fracture /
- Elderly patients /
- Centrum /
- Operation /
- Postoperative cognitive dysfunction /
- Risk factors
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表 1 老年椎体压缩性骨折患者发生POCD的单因素分析
Table 1. Univariate analysis of POCD after lower extremity fracture surgery in elderly patients
因素 认知功能障碍组(n=39) 正常组(n=128) 统计量 P值 年龄(x±s，岁) 72.28±5.37 66.37±4.68 6.666a ＜0.001 性别(例) 0.684b 0.408 男性 20 56 女性 19 72 BMI(x±s) 23.69±3.61 24.09±3.49 0.622a 0.535 婚姻状况(例) 2.198b 0.333 已婚 20 70 未婚 9 38 丧偶 10 20 受教育年限(x±s) 8.69±2.51 9.36±2.60 1.201a 0.233 骨折位置(例) 2.113b 0.348 T12 12 35 L1 20 55 L2 7 38 吸烟史(例) 0.011b 0.914 是 24 80 否 15 48 饮酒史(例) 4.767b 0.029 是 18 84 否 21 44 合并内科疾病数量(例) 1.054b 0.304 ≥3 25 93 ＜3 14 35 术后是否感染(例) 5.986b 0.014 是 12 68 否 27 60 围手术期是否镇痛(例) 24.220b ＜0.001 是 15 102 否 24 26 术后是否有其他并发症(例) 4.132b 0.042 是 15 73 否 24 55 睡眠障碍史(例) 0.005b 0.946 是 24 78 否 15 50 术中是否使用非甾体类抗炎药(例) 1.349b 0.246 是 19 49 否 20 79 术中是否使用右美托咪定(例) 0.582b 0.446 是 21 60 否 18 68 麻醉方式(例) 9.405b ＜0.001 全身麻醉 28 56 其他 11 72 手术时间(例) 15.759b ＜0.001 ≥120 min 30 52 ＜120 min 9 76 术中出血量(x±s，mL) 186.09±36.37 192.37±41.26 0.854a 0.394 术中额叶平均脑氧饱和度(x±s，%) 63.52±3.69 66.68±4.01 4.387a ＜0.001 术前白细胞计数(x±s，×109/L) 6.31±2.23 6.14±2.10 0.436a 0.663 术前血红蛋白浓度(x±s，g/L) 102.36±12.68 101.55±11.50 0.376a 0.708 术前血钠浓度(x±s，mmol/L) 137.69±5.06 136.62±4.57 1.248a 0.214 术前血钾浓度(x±s，mmol/L) 4.56±0.83 4.66±0.90 0.618a 0.537 术前焦虑评分(x±s，分) 7.36±2.13 6.35±1.82 2.913a 0.004 注：a为t值，b为χ2值。 
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表 2 变量的赋值情况
Table 2. The assignment of a variable
因素 赋值方法 年龄 年龄＜65岁=0，年龄≥65岁=1 围手术期是否镇痛 否=0，是=1 麻醉方式 其他=0，全身麻醉=1 手术时间 ＜120 min=0，≥120 min=1
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表 3 老年椎体压缩性骨折患者发生POCD的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of POCD in elderly patients with vertebral compression fractures
因素 B SE Wald χ2 P值 OR值 95% CI 年龄 1.208 0.451 7.174 0.007 3.347 1.383~8.101 围手术期是否镇痛 0.827 0.409 4.089 0.043 2.286 1.026~5.097 麻醉方式 1.366 0.492 7.709 0.005 3.920 1.494~10.281 手术时间 1.229 0.292 17.715 ＜0.001 3.418 1.928~6.058
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