| Objective:Postoperative delirium(POD)is a delirium that occurs after a patient’s surgery,which is common in older patients.Although many risk factors have been identified,no reversible factors,particularly ones potentially modifiable by anaesthetic management,have been identified.The goal of this prospective study was to investigate whether intraoperative blood pressure fluctuation was associated with postoperative delirium in older patients undergoing non-cardiac surgery.Methods:Study subjects were patients over 65 years of age,undergoing non-cardiac surgery,whose ASA grade is II-III,under general anesthesia at The second Hospital of Dalian Medical Unversity from July 19 to October 19,2019.The following patients were excluded:Patients who refused the study;patients whose family refused the study;patients who had a history of central nervous system disease or mental illness,patients who combined with severe cardiovascular disease;patients who had liver or kidney dysfunction,severe infection,severe anemia,low cardiac ejection fraction,carotid stenosis,visual impairment,hearing impair ment,alcoholism,electrolyte disorders;patients with acid-base imbalance,urinary retention,constipation,sleep disturbance,restricted mobility,hypoxemia;patients with severe pain that cannot be relieved by medication;patients whose bleeding volume was more than 400 ml or the patients received blood transfusion treatment.A anesthetist conducted the preoperative interviews 1 day before surgery from the Mini Mental State Examination.Patients with a score below 27 were excluded.The sex,age,BMI,history of hypertension,history of diabetes,history of TIA,latest hemoglobin measured before surgery,glomerular filtration rate value,ASA classification,type of surgery,intraoperative blood loss,urine volume,fluid volume,duration of operation and dosage of various drugs of the patients were recorded.All patients underwent fast-induced intravenous-breathing anesthesia with tracheal intubation or laryngeal mask.Vital signs during the operation were recorded.The anesthesiologist decided whether to establish invasive blood pressure.The anesthesiologist was blind of this study.If invasive blood pressure is established,invasive blood pressure was recorded,otherwise non-invasive cuff blood pressure was recorded.VAS was used to evaluated the degree of pain during three days after surgery.POD was measured by the RASS and the CAM-ICU on the three postoperative days.AUC,num and variance were considered as indicators of blood pressure fluctuations.Patients were divided into POD and non-POD groups,measurement data were analysed using t-test,categorical variables were analysed by C hi—squared test.Logistic univariate regression analysis was used to screen the independent variables,and then multivariate logistic regression analysis was used to find the risk factors of POD.Results:654 people were assessed by MMSE before the operation.564 patients which were accorded with the inclusion criteria came into the study,and 85 patients developed POD in the three days,479 patients developed non-POD.The incidence of POD was 15.07%.There were no significant differences between POD group and non-POD group in BMI,reoperative hemoglobin,preoperative MMSE score,sex,ASA classification,type of operation,bleeding volume,intraoperative midazolam dosage,penehyclidine hydrochloride dosage,norepinephrine dosage,score of VAS,history of hypertension,history of diabetes,history of TIA and DBP baseline(P>0.05).There were significant differences between POD group and non-POD group in age,duration of operation,SBP baseline,SBP variance,SBP AUC,DBP AUC and DBP num(P<0.05).Multivariate logistic regression analysis:The correlative factors of POD were the age(P=0.003,OR:1.064,95%CI:1.021~1.108),and SBP AUC(P=0.005,OR:1.001,95%CI:1.001~1.001).Conclusion: Age and blood pressure fluctuations were predictive factors of postoperative delirium. |
PDF Full Text Request