急性脑梗死患者颅内血管狭窄介入术后谵妄的影响因素分析

Influencing factors for delirium after interventional surgery for intracranial vascular stenosis in patients with acute cerebral infarction

摘要:

目的 分析急性脑梗死患者颅内血管狭窄介入术后发生谵妄的影响因素。方法 纳入2021年6月至2024年6月在郑州市第七人民医院进行颅内血管狭窄介入术的急性脑梗死患者120例，根据意识模糊评估法进行术后谵妄评估，将患者分为术后谵妄组（35例）和非术后谵妄组（85例）。比较两组临床资料、心率（HR）、平均动脉压（MAP），以及血清S-100β蛋白、神经元特异性烯醇化酶（NSE）、肿瘤坏死因子α（TNF-α）和白细胞介素-1β（IL-1β）水平，并分析影响术后发生谵妄的风险因素。结果 相较于非术后谵妄组，术后谵妄组平均年龄更大、受教育年限更短、手术侧区域性脑氧饱和度（rScO₂）基础值更低（P<0.05）。两组患者各时间点HR和MAP比较，差异无统计学意义（P>0.05）。相较于非术后谵妄组，术后谵妄组S-100β蛋白、NSE、TNF-α、IL-1β水平更高（P<0.05）。多因素Logistic回归分析显示，年龄、S-100β蛋白、NSE、TNF-α、IL-1β、受教育年限、手术侧rScO₂基础值均为术后谵妄发生的影响因素（均P<0.05）。结论 术后谵妄的发生与患者的年龄、受教育年限、手术侧rScO₂基础值以及S-100β蛋白、NSE、TNF-α、IL-1β的水平密切相关。

Abstract:

To investigate the influencing factors for delirium after interventional surgery for intracranial vascular stenosis in patients with acute cerebral infarction.Methods A total of 120 patients with acute cerebral infarction who underwent interventional surgery for intracranial vascular stenosis in The Seventh People’s Hospital of Zhengzhou from June 2021 to June 2024 were enrolled， and according to the presence or absence of postoperative delirium assessed by the Confusion Assessment Method， the patients were divided into postoperative delirium group with 35 patients and non-postoperative delirium group with 85 patients. The two groups were compared in terms of clinical data， heart rate （HR）， mean arterial pressure （MAP）， and the serum levels of S-100β protein， neuron-specific enolase （NSE）， tumor necrosis factor-α （TNF-α）， and interleukin-1β （IL-1β）， and the risk factors for postoperative delirium were analyzed.Results Compared with the non-postoperative delirium group， the postoperative delirium group had a significantly higher mean age， a significantly shorter duration of education， and a significantly lower baseline value of regional cerebral oxygen saturation （rScO?） on the surgical side （P<0.05）. There were no significant differences in HR and MAP between the two groups at each time point （P>0.05）. The postoperative delirium group had significantly higher levels of S-100β protein， NSE， TNF-α， and IL-1β than the non-postoperative delirium group （P<0.05）. The multivariate logistic regression analysis showed that age， S-100β protein， NSE， TNF-α， IL-1β， duration of education， and baseline rScO? on the surgical side were influencing factors for postoperative delirium （all P<0.05）.Conclusions The onset of postoperative delirium is closely associated with age， duration of education， baseline rScO? on the surgical side， and the serum levels of S-100β protein， NSE， TNF-α， and IL-1β.