2023 年第 4 期 第 18 卷

中高危阻塞性睡眠呼吸暂停与腹腔镜手术患者术后谵妄的关系研究

Study on the relationship between intermediate-high risk of obstructive sleep apnea and postoperative delirium in patients undergoing laparoscopic surgery

作者：邹毅1李娜1李亚锟1齐翔2邢丽娇1郑莉1

英文作者：Zou Yi1 Li Na1 Li Yakun1 Qi Xiang2 Xing Lijiao1 Zheng Li1

单位：1首都医科大学附属北京友谊医院麻醉科，北京100050；2首都医科大学三博脑科医院麻醉科，北京100093

英文单位：1Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 2Department of Anesthesiology Sanbo Brain Hospital Capital Medical University Beijing 100093 China

关键词：阻塞性睡眠呼吸暂停；术后谵妄；STOP-Bang量表；腹腔镜手术

英文关键词：Obstructivesleepapnea;Postoperativedelirium;STOP-Bangscore;Laparoscopicsurgery

• 摘要：

• 目的 探讨中高危阻塞性睡眠呼吸暂停（OSA）与腹腔镜手术患者术后谵妄的关系。方法 回顾性分析2021年4月至2022年7月在首都医科大学附属北京友谊医院全身麻醉下择期腹腔镜手术的141例患者的前瞻性队列数据。使用STOP-Bang问卷（SBQ）筛查患者OSA的情况，根据结果将患者分为OSA低危组（SBQ分数<3分，77例）和OSA中高危组（SBQ分数≥3分，64例）。主要终点指标是通过3 min谵妄诊断量表或重症监护病房患者意识模糊评估法以及Richmond躁动-镇静评分来判断术后谵妄的发生情况，分为术后谵妄阳性组（30例）与术后谵妄阴性组（111例）。收集围术期与术后谵妄相关的各种高危因素，进行单因素分析以及倾向性得分匹配分析，评估OSA中高危患者术后谵妄的风险。结果 术后谵妄阳性组术前低蛋白比例低于术后谵妄阴性组，OSA中高危比例［66.7%（20/30）比39.6%（44/111）］及术中舒芬太尼用量高于术后谵妄阴性组，差异均有统计学意义（均P＜0.05）。在排除混杂因素前，OSA低危组患者和OSA中高危组患者在性别、高血压病、术前贫血、吸烟比例及术中舒芬太尼用量方面差异均有统计学意义（均P<0.05）。在排除混杂因素影响后，分析显示OSA中高危患者发生术后谵妄的风险显著升高，比值比为4.667（95%置信区间：1.395～15.616，P=0.012）。结论 术前通过SBQ筛查出的OSA中高危患者腹腔镜手术后发生谵妄的风险高。

• Objective To discuss the relationship between intermediate-high risk of obstructive sleep apnea(OSA) and postoperative delirium(POD) in patients undergoing laparoscopic surgery. Methods From April 2021 to July 2022, the prospective cohort data of 141 patients undergoing elective laparoscopic surgery under general anesthesia in Beijing Friendship Hospital, Capital Medical University were analyzed retrospectively. The STOP-Bang questionnaire(SBQ) was used to screen patients for OSA. According to the results, patients were divided into OSA low risk group(SBQ score<3, 77 cases) and OSA intermediate-high risk group(SBQ score≥3, 64 cases). The main end point was the occurrence of POD determined by the 3 min delirium diagnostic scale or the confusion assessment method for intensive care unit and Richmond agitation and sedation scale. They were divided into POD positive group(30 cases) and POD negative group(111 cases). Various high risk factors related to POD during the perioperative period were collected， and single factor analysis and propensity score matching analysis were used to assess the risk of POD in intermediate-high risk patients with OSA. Results The proportion of preoperative low protein in the POD positive group was lower than that in the POD negative group, and the proportion of OSA intermediate-high risk ［66.7%（20/30） vs 39.6%（44/111）］ and the amount of sufentanil dosage during operation were higher than those in the POD negative group(all P<0.05). Before removing the confounding factors, there were statistically significant differences in proportions of gender, hypertension, preoperative anemia, smoking and the amount of sufentanil dosage during the operation between patients in OSA low risk group and OSA intermediate-high risk group (all P<0.05). After removing the influence of confounding factors, the analysis showed that the risk of POD in OSA intermediate-high risk patients was significantly higher, with an odds ratio of 4.667(95% confidence interval: 1.395-15.616, P=0.012). Conclusion Intermediate-high risk of OSA patients, screened by SBQ before operation, has high risk of delirium after laparoscopic surgery.