| 周松杰,姜跃国,蔡万松,张斌,庄云强.骨科手术患者继发术后认知功能障碍的危险因素研究[J].浙江中西医结合杂志,2018,28(7): |
| 骨科手术患者继发术后认知功能障碍的危险因素研究 |
| Establishment of Clinical Prediction Model of Secondary post-operative cognitive dysfunction in orthopedic surgery and applied research |
| 投稿时间：2017-08-22 修订日期：2018-04-27 |
| DOI： |
| 中文关键词: 骨科/骨外科 围手术期 认知功能 |
| 英文关键词:Orthopedic perioperative cognitive function |
| 基金项目: |
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| 摘要点击次数: 642 |
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| 中文摘要: |
| 目的：搜集骨科患者围手术期相关临床指标,构建预测模型以评判继发术后认知功能障碍(Post-operative cognitive dysfunction, POCD)的预测价值,并评判预测模型的应用性。 方法：连续性纳入宁波市奉化区人民医院于2015年02月至2017年05月期间收治的骨科手术的患者为观察队列,搜集相关临床资料,并观察术后7日内继发的预后转归情况。依据随访结果预判继发POCD风险的影响性指标,并分析其中连续性指标的临界值。 结果：本次研究最终纳入413例接受骨科手术的患者,其中23例患者于术后7日内继发POCD、390例患者于相应时间窗内未见相关异常。①Cox回归分析显示,骨科手术继发POCD的风险模型由年龄、手术分级：四级、超前镇痛、手术耗时、术后VAS评分、术后PCT含量组成,其中接受超前镇痛为保护性因素,其余因素为危险性因素；②ROC曲线显示,年龄≥61.42岁、手术耗时≥3.06h、术后VAS评分≥3.74分为骨科手术继发POCD的临界指标,具有更显著的评判效能。 结论：年龄、第四级手术、接受超前镇痛、手术耗时、术后VAS评分、术后PCT含量是骨科手术继发POCD的独立影响因素,其中年龄≥61.42岁、手术耗时≥3.06h、术后VAS评分≥3.74分为继发POCD的评判临界点。 |
| 英文摘要: |
| Objective: To investigate the predictive value of secondary postoperative-related clinical indicators, to construct the predictive model to evaluate the predictive value of secondary post-operative anxiety function (POCD), and to evaluate the applicability of the predictive model. Methods: The clinical data were collected from the patients undergoing orthopedic surgery from February 2015 to May 2017 in Feng-hua District, Ningbo City. The clinical data were collected and the prognosis was observed within 7 days after operation. According to the follow-up results, the influence index of secondary risk of POCD was predicted and the critical value of continuity index was analyzed. Results: The study included 413 patients who underwent orthopedic surgery, 23 of whom had secondary POCD within 7 days postoperatively, and 390 patients had no associated abnormalities in the corresponding time window. ①Cox regression analysis showed that the risk model of secondary management of orthopedic surgery was composed of age, surgical grade: grade four, advanced analgesia, time-consuming operation, postoperative VAS score and postoperative PCT content, which included advanced analgesia as protective factor , The remaining factors are risk factors; ②ROC curve shows that the age≥61.42 years old, the operation time≥3.06h, postoperative VAS score≥3.74 divided into orthopedic surgery secondary to the critical indicators of POCD, with a more significant evaluation of efficacy. Conclusion: Age, the fourth stage of surgery, to accept advanced analgesia, surgery time, postoperative VAS score, postoperative PCT content is secondary to orthopedic surgery POCD independent influencing factors, Which age≥61.42 years old, the operation time≥3.06h, postoperative VAS score≥3.74 divided into the secondary point of the critical point of POCD. |
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