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目的:探讨创伤性休克病人术后谵妄的临床相关影响因素。方法 :选择急诊手术的创伤性休克病人50例,男31例,女19例,年龄19～68岁。术前、术后12 h及术后第1、2、3天随访病人,用意识模糊谵妄评定法进行谵妄评估。记录病人血乳酸、血糖、颈内静脉血氧饱和度、血肌酐、血尿素氮和血半胱氨酸蛋白酶抑制剂C浓度值,检测术中失血量及术后谵妄的发生情况,建立数据库。根据是否发生谵妄分为谵妄组和对照组。结果:发生术后谵妄23例,发生率为46%。多因素logistic逐步回归分析发现病人年龄大、高乳酸血症、高血糖、颈内静脉血氧饱和度降低、急性肾功能损伤及术中失血量大均是谵妄的危险因素(P<0.05)。结论:年龄大、高乳酸血症、高血糖、颈内静脉血氧饱和度降低、急性肾功能损伤及术中大量失血为创伤性休克病人术后谵妄的危险因素。
Objective: To investigate the clinically relevant factors of postoperative delirium in patients with traumatic shock. Methods: Fifty patients with traumatic shock who were selected for emergency surgery were 31 males and 19 females, aged 19-68 years. Preoperative, postoperative 12 h and postoperative 1, 2, 3 days follow-up of patients, with delirium delirium assessment method to evaluate delirium. Blood lactate, blood glucose, blood oxygen saturation of jugular vein, serum creatinine, blood urea nitrogen and blood cystatin C concentrations were recorded. The blood loss and postoperative delirium were measured to establish the database. According to whether delirium is divided into delirium group and control group. Results: There were 23 cases of postoperative delirium, the incidence was 46%. Multivariate logistic stepwise regression analysis found that patients with age, hyperlipidemia, hyperglycemia, decreased blood oxygen saturation of jugular vein, acute renal injury and intraoperative blood loss were risk factors for delirium (P <0.05). Conclusion: Age, hyperlipidemia, hyperglycemia, decreased blood oxygen saturation of the internal jugular vein, acute renal injury and massive blood loss during operation are the risk factors of postoperative delirium in patients with traumatic shock.