老年骨科手术患者麻醉后认知功能障碍的多因素分析及模型预测初步研究

摘要 目的：探讨分析影响老年骨科手术患者麻醉后的认知功能障碍的因素并建立预测模型。方法：将2016年1月至2019年1月于我院骨科行手术的227例老年患者根据术后认知功能障碍评分分为认知障碍组及无障碍组，比较两组一般资料及手术方式、麻醉方式等手术相关因素，使用多因素Logistic回归模型分析影响术后认知功能障碍发生的因素，使用R软件建立出现认知功能障碍的列线图预测模型，并验证其效能。结果：术后共有65例患者出现认知功能障碍，认知障碍组患者的年龄、行全麻的患者比例、术中失血量、手术时间及出现术后并发症患者比例均明显高于无障碍组，而术中血压及应用超前镇痛患者比例均明显低于无障碍组（均P＜0.05）；而两组患者性别、BMI及手术部位等指标则无明显差异（均P＞0.05）；多因素Logistic回归分析示高龄、全麻、术中失血量过多、过长手术时间及术后出现并发症均是老年骨科手术患者术后出现认知障碍的独立危险因素（OR=1.077,3.796,3.826,1.712，6.937；均P＜0.05）；而术中高收缩压、舒张压及术前给予超前镇痛是术后出现认知功能障碍的保护因素（OR=0.953,0.913,0.333；均P＜0.05）；列线图预测认知功能障碍发生的一致性指数（C-index）为0.904（95%Cl 0.862~0.961）。结论：高龄、全麻、无超前镇痛、手术时间过长、术中失血量过多、术中低血压及术后出现并发症是出现术后认知功能障碍的危险因素，基于此构建的列线图可有效对术后认知功能障碍进行预测，具有较好的临床应用价值。

Cognitive Dysfunction in Elderly Patients after Orthopedic Surgery Multi-factor Analysis and Preliminary Study of Model Prediction

ABSTRACT Objective: Analyze the factors that affect the cognitive dysfunction after anesthesia in elderly orthopedic surgery patients, and establish a predictive model. Methods: According to the postoperative cognitive dysfunction score, 227 elderly patients undergoing surgery in our hospital''s orthopedics from January 2016 to January 2019 were divided into cognitive impairment group and barrier-free group. Compare the general information, surgical methods, anesthesia methods and other surgical related factors between the two groups, using the multivariate logistic regression model to analyze the factors that affect postoperative cognitive dysfunction, using the R software to establish a nomogram prediction model for cognitive dysfunction and verify its effectiveness. Results: After surgery 65 patients had cognitive dysfunction. The age, the proportion of patients undergoing general anesthesia, the amount of blood loss during surgery, the duration of surgery, and the proportion of patients with postoperative complications of the patients in the cognitive impairment group, were significantly higher than those in the barrier-free group, the intraoperative blood pressure and the proportion of patients with advanced analgesia were significantly lower than those in the barrier-free groups (both P<0.05); while there were no significant differences between the two groups in terms of gender, BMI, surgical site and the other indexes (both P>0.05); multiple factors Logistic regression analysis showed that advanced age, general anesthesia, excessive blood loss during operation, excessive operation time and postoperative complications are independent risk factors for postoperative cognitive impairment in elderly orthopedic surgery patients (OR=1.077, 3.796, 3.826, 1.712, 6.937; both P<0.05); high intraoperative systolic blood pressure, diastolic blood pressure, and preoperative analgesia given before surgery are protective factors for cognitive dysfunction after surgery (OR=0.953, 0.913, 0.333; both P<0.05); the nomogram predicts the consistency index (C-index) of cognitive dysfunction occurrence is 0.904 (95% Cl 0.862~0.961). Conclusion: Old age, general anesthesia, no advanced analgesia, long operation time, excessive blood loss during operation, intraoperative hypotension and postoperative complications are risk factors for cognitive dysfunction after operation The map can effectively predict postoperative cognitive dysfunction and has good clinical application value.