Analysis of influencing factors of postoperative cognitive dysfunction in elderly patients with spinal tuberculosis

doi:10.3969/j.issn.1000-6621.2021.05.006

Abstract

Abstract:

Objective To analyze the influencing factors of the postoperative cognitive dysfunction in elderly spinal tuberculosis patients undergoing the surgery, and to provide scientific evidence for the effective prevention of the perioperative neurocognitive disorders (PND). Methods A prospective observational research was conducted with 102 elderly spinal tuberculosis patients undergoing spinal surgery from Hangzhou Red Cross Hospital between January 2019 and June 2020. Clinical data of the patients were collected. Regional oxygen saturation (rSO₂) was continuously measured during the operation, the cognitive function was also assessed by mini-mental state examination (MMSE) before and after the operation to analyze the influential factors of PND in elderly spinal tuberculosis patients after surgery. Results Among the 102 patients, 10 withdrawn and the other 92 completed the study. Of these 92 patients, 74 (80.43%) did not occur PND, and 18 (19.57%) occurred PND 7 days after operation, and 10 cases recovered 30 days postoperative. A univariate analysis revealed that the duration of rSO₂ <60% intraoperative was 41.5 (33.5, 64.7) minutes in patients with PND, which was significantly longer than that in patients without PND (0.0 (0.0, 5.8) minutes, Z=-6.454, P=0.001). The multivariate logistic regression analysis showed that the risk of PND in patients with the duration of rSO₂ <60% during 31-59 minutes was 5.903 (95%CI: 1.228-28.385) times as high as that in patients with the duration ≤30 minutes; the risk of PND in patients with the duration ≥60 minutes was 10.168 (95%CI: 1.177-87.857) times as high as that in patients with the duration ≤30 minutes. Conclusion The long duration of rSO₂ <60% in the spinal tuberculosis surgery was a risk factor of PND. During the operation, attention should be paid to the change of cerebral oxygen saturation, and the timely intervention would help to avoid low cerebral oxygen saturation in patients.

Key words: Tuberculosis, spinal, Aged, Postoperative complications, Cognition disorders, Prospective studies

WAN Hai-fang, TAO Fan, ZHAO Jie, CHEN Yuan-hui, HUANG Yan-ming, FU Yun-bin. Analysis of influencing factors of postoperative cognitive dysfunction in elderly patients with spinal tuberculosis[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 441-445. doi: 10.3969/j.issn.1000-6621.2021.05.006

Figures/Tables 3

影响因素	对照组(74例)	发病组(18例)	统计检验值	P值
性别[例(构成比,%)]			χ²=0.053	0.466
男	44(59.46)	9(50.00)
女	30(40.54)	9(50.00)
年龄(岁, $x ˉ$ ±s)	69.69±6.99	68.17±6.52	t=0.839	0.404
BMI( $x ˉ$ ±s)	20.37±1.26	20.04±1.62	t=0.924	0.358
受累病椎数			χ²=0.027	0.870
>2	52(70.27)	13(72.22)
≤2	22(29.73)	5(27.78)
麻醉时间(min, $x ˉ$ ±s)	351.85±27.21	354.94±25.17	t=-0.439	0.662
失血量(ml, $x ˉ$ ±s)	331.00±129.90	340.14±104.15	t=-0.294	0.769
最低血球压积(%, $x ˉ$ ±s)	28.72±3.81	27.64±4.25	t=1.055	0.295
住院时间(d, $x ˉ$ ±s)	11.50±1.64	12.28±1.64	t=-1.804	0.075
VAS₁ (分, $x ˉ$ ±s)	3.81±0.87	4.17±0.86	t=-1.559	0.122
VAS₂ (分, $x ˉ$ ±s)	2.14±0.75	2.28±0.75	t=-0.726	0.470
VAS₃ [分,M(Q₁,Q₃)]	0.8(0.0,1.0)	0.5(0.0,1.0)	Z=-9.520	0.341
并发糖尿病[例(构成比,%)]			χ²=9.719	0.009
是	7(9.46)	7(38.89)
否	67(90.54)	11(61.11)
并发高血压[例(构成比,%)]			χ²=0.316	0.574
是	44(59.46)	12(66.67)
否	30(40.54)	6(33.33)
术前rSO₂(%, $x ˉ$ ±s)	70.59±2.54	71.28±3.92	t=-0.911	0.365
术中平均rSO₂(%, $x ˉ$ ±s)	66.69±2.76	64.33±3.66	t=3.037	0.003
最低rSO₂(%, $x ˉ$ ±s)	61.58±4.15	55.94±2.78	t=5.463	0.001
rSO₂低于60%的时长[min,M(Q₁,Q₃)]	0.0(0.0,5.8)	41.5(33.5,64.7)	Z=-6.454	0.001
简易智力状态检查(分, $x ˉ$ ±s)
术前	28.01±1.05	27.83±0.93	t=0.666	0.507
术后7d	27.66±0.85	24.94±1.35	t=10.763	0.001
术后30d	27.40±1.86	25.83±1.67	t=3.272	0.002

影响因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
住院时间	0.062	0.233	0.071	0.789	1.064(0.675~1.667)
VAS₁	0.683	0.461	2.195	0.138	1.980(0.802~4.886)
并发糖尿病	1.828	0.965	3.586	0.058	6.220(0.938~41.255)
术中平均rSO₂	-0.032	0.123	0.066	0.797	0.969(0.761~1.233)
术中最低rSO₂(以≥60%为参照)
55%~59%	-0.518	1.471	0.124	0.725	0.596(0.033~10.649)
50%~54%	1.028	0.798	1.661	0.197	2.796(0.585~13.356)
rSO₂低于60%持续时间(以≤30min为参照)
31~59min	1.775	0.801	4.910	0.027	5.903(1.228~28.385)
≥60min	2.319	1.100	4.443	0.035	10.168(1.177~87.857)
常量	16.386	8.883	3.402	0.065

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变量	赋值	变量	赋值
围手术期神经认知障碍	是=1,否=0	术中最低rSO₂	≥60%=1,55%~59%=2,50%~54%=3
并发糖尿病	是=1,否=0	rSO₂低于60%持续时间	≤30min=1,31~59min=2,≥60min=3