老年肺癌根治术病人术前衰弱与术后谵妄或亚谵妄综合征的相关性研究

宁允; 于蓉; 吴冰; 邾萍; 高红; 裴义; 钱晨; 张柳柳

老年肺癌根治术病人术前衰弱与术后谵妄或亚谵妄综合征的相关性研究

Study on the correlation between preoperative frailty and postoperative delirium or subdelirium syndrome in elderly lung cancer patients treated with radical resection

摘要

摘要:
目的： 探讨老年肺癌根治术病人术前衰弱与术后谵妄或亚谵妄综合征之间的关系。
方法： 采用便利抽样法，选取行肺癌根治术老年病人454例为研究对象，依据术前中文版Tilburg衰弱评估量表评分，将病人分为衰弱组115例和非衰弱组339例。收集病人相关临床资料，采用logistics回归分析筛选术后谵妄或亚谵妄综合征发生的危险因素，并采用ROC曲线分析相关指标对病人术后谵妄或亚谵妄综合征的预测价值。
结果： 454例老年肺癌根治术病人中，发生亚谵妄综合征86例，谵妄76例，术后谵妄或亚谵妄综合征发生率为35.68%（162/454）。其中，衰弱组术后谵妄或亚谵妄综合征的发生率为67.83%（78/115），明显高于非衰弱组的24.78%（84/339）（P ＜ 0.01）。在调整独居、文化程度、术后低体温、MMSE得分等因素后，衰弱组病人发生谵妄或亚谵妄综合征的风险高于非衰弱组（OR = 6.971，95%CI：4.194 ~ 11.587），中文版Tilburg衰弱评估量表预测老年肺癌根治术病人术后谵妄或亚谵妄综合征发生的AUC为0.677（95%CI：0.632 ~ 0.723）。
结论： 老年肺癌根治术病人术前衰弱可增加术后谵妄或亚谵妄综合征的发生风险，且在一定程度上可预测术后谵妄或亚谵妄综合征的发生。

Abstract:
Objective To investigate the relationship between preoperative frailty and postoperative delirium or subsyndromal delirium in elderly patients after radical lung cancer surgery.
Methods By using the convenience sampling method, 454 elderly patients undergoing radical resection of lung cancer were selected as the research subjects. According to the preoperative Chinese version of the Tilburg Frailty Assessment Scale score, the patients were divided into the frailty group (115 cases) and non-frailty group (339 cases). The relevant clinical data of the patients were collected. Logistic regression analysis was used to screen the risk factors for the occurrence of postoperative delirium or subdelirium syndrome, and the ROC curve was used to analyze the predictive value of relevant indicators for postoperative delirium or subdelirium syndrome.
Results Among 454 elderly patients undergoing radical resection of lung cancer, 86 cases developed subdelirium syndrome, and 76 cases developed delirium. The incidence of postoperative delirium or subdelirium syndrome was 35.68% (162/454). Among them, the incidence of postoperative delirium or subdelirium syndrome in the frailty group was 67.83% (78/115), which was significantly higher than 24.78% (84/339) in the non-frailty group (P ＜ 0.01). After adjusting for factors such as living alone, educational level, postoperative hypothermia, and MMSE score, the risk of delirium or subdelirium syndrome in the frailty group was higher than that in the non-frailty group (OR = 6.971, 95%CI: 4.194–11.587), the AUC of the Chinese version of the Tilburg Flimsy Scale in predicting the occurrence of postoperative delirium or subdelirium syndrome in elderly patients undergoing radical resection of lung cancer was 0.677 (95%CI: 0.632–0.723).
Conclusions Preoperative frailty in elderly patients undergoing radical lung cancer surgery can increase the risk of postoperative delirium or subdelirium syndrome, and to a certain extent, it can predict the occurrence of postoperative delirium or subdelirium syndrome.

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