在老年人关节骨折手术中,手术内血压变化和术后狂妄的相关性
Peng Yang1, Yu Fan2, Wanyun Tang3
1Department of Anesthesiology, Zigong First People's Hospital, 643000, Zigong, People's Republic of China.
Scientific reports
|April 29, 2025
概括
在老年关节骨折患者中,手术后血压变化 (BPV) 的增加与术后狂妄症 (POD) 的风险更高有关. 管理BPV可能有助于减少POD发病率.
科学领域:
- 老年麻醉学老年麻醉学
- 外科手术患者的结果
- 神经临界护理是指神经临界护理.
背景情况:
- 手术后痴呆症 (POD) 是接受关节骨折手术的老年患者的常见并发症.
- 术后血压变化 (BPV) 被认为是POD的潜在危险因素.
- 优化管理策略以减轻这种脆弱人群中POD风险至关重要.
研究的目的:
- 为了研究手术内血压变化 (BPV) 与手术后狂妄症 (POD) 在经历骨折手术的老年患者中的发生率之间的关联.
- 确定高BPV是否是POD的独立预测因素.
- 探索BPV和POD之间的剂量反应关系和潜在效果修饰因素.
主要方法:
- 对1002名接受关节骨折手术的老年患者进行了回顾性分析.
- 使用平均动脉压变化系数 (CV-MAP) 来量化手术内血压.
- 使用了倾向得分匹配 (PSM),多变量逻辑回归和受限立方线 (RCS) 分析.
主要成果:
- 手术后痴呆症 (POD) 在19.8%的患者中发生.
- 较高的手术内BPV (CV-MAP>10%) 与POD发病率的增加显著相关 (25.2%与PSM后18.9%相比,p=0.032).
- 升高的CV-MAP是POD的独立预测因子 (aOR: 1.45,95%CI 1.03-2.03),观察到非线性正相关性.
结论:
- 在老年关节骨折患者中,增加的手术内血压变化 (BPV) 与术后狂妄症 (POD) 的风险增加独立相关.
- 非线性效应和与年龄和ASA分类等因素的相互作用改变了这种关联.
- 在手术期间个性化血压管理对于降低POD风险在这个患者群体中很重要.
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