成年胶质瘤患者肿瘤分级与术后谵妄的关系

Q4 Medicine

中华神经外科杂志 Pub Date : 2020-03-28 DOI:10.3760/CMA.J.CN112050-20190928-00416

Huawei Huang, Guobin Zhang, Xiaokang Zhang, Chun-Mei Wang, Jingran Chen, Yu-Mei Wang, Ming Xu, Song Lin, Jian-Xin Zhou

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引用次数: 0

摘要

目的分析脑胶质瘤术后谵妄（POD）的发生率及危险因素，探讨肿瘤分级与POD的关系。方法对2017年3月至2018年2月在首都医科大学北京天坛医院重症医学室（ICU）进行的800名神经外科患者的单中心、前瞻性队列研究中113名成年神经胶质瘤患者的临床数据进行第二次分析。使用Richmond激动镇静量表（RASS）和ICU困惑评估方法（CAM-ICU）对患者在术后第一至第三天（每天两次）的谵妄进行评估。根据患者是否有谵妄分为谵妄组（43例）和非谵妄组70例。我们收集了患者的一般术前信息、术前情况、术后早期临床数据和神经外科专业数据（包括世界卫生组织等级），作为可能与POD发生相关的潜在危险因素。采用多元logistic回归分析确定POD的独立危险因素。特别探讨了世界卫生组织脑胶质瘤分级与POD的关系。结果113例神经胶质瘤患者在ICU接受术后常规监测，POD发生率为38.1%（43/113）。世界卫生组织Ⅰ-Ⅳ级胶质瘤POD发生率随世界卫生组织分级的增加而增加：7.7%（1/13）、14.3%（3/21）、22.7%（5/22）和63.0%（34/57）。在潜在危险因素中，年龄（OR=1.08，95%CI:1.04-1.13，P<0.001）、入住ICU时的GCS（格拉斯哥昏迷量表）评分（OR=0.80，95%CI:7.71-0.90，P<001）和世界卫生组织肿瘤分级（OR=2.01，95%CI:1.03-3.92，P=0.041）是POD的独立危险因素。结论胶质瘤世界卫生组织分级是POD的独立危险因素。随着肿瘤分级的增加，POD的发生率也随之增加。关键词：胶质瘤；神经外科手术；谵妄；肿瘤分级；神经可塑性补偿

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Relationship between tumor grade and postoperative delirium in adult patients with glioma

Objective To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD. Methods A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored. Results In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. Conclusions The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases. Key words: Glioma; Neurosurgical procedures; Delirium; Neoplasm grading; Compensa-tory neuroplasticity

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.