高血压脑出血患者术后发生谵妄的危险因素及预后的调查研究

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　　[摘要]目的 探討高血压患者脑出血术后出现谵妄的危险因素及预后情况。方法 选取2017年5月～2018年8月在我院收治的术后130例高血压脑出血患者作为研究对象，采用自行设计的调查问卷分析高血压脑出血术后谵妄发生情况、危险因素及预后情况。结果 共130例患者，有37例出现术后谵妄，谵妄发病率为28.46%。单因素分析结果提示，发生谵妄和未发生谵妄高血压脑出血术后患者的年龄、出血量、手术时间、术后格拉斯哥昏迷指数评分（GCS）、机械通气以及术后低氧血症等6个因素比较，差异有统计学意义（P<0.05）。多因素Logistic分析结果提示，年龄（β=-0.854，OR=2.342，P<0.05）、出血量（β=-0.752，OR=1.756，P<0.05）、手术时间（β=-0.672，OR=1.526，P<0.05）、术后GCS评分（β=-0.558，OR=3.514，P<0.05）和术后低氧血症（β=-0.652，OR=4.514，P<0.05）是高血压脑出血患者术后发生谵妄的危险因素，而机械通气是其保护因素（β=0.614，OR=0.862，P<0.05）。高血压脑出血患者术后发生谵妄的90 d存活有21例，存活率为56.76%，明显低于未发生谵妄高血压脑出血术后患者的81例（87.10%），差异有统计学意义（P<0.05）。结论 高血压脑出血术后谵妄发生受多种因素的影响，且与术后患者生存率密切相关。
　　[关键词]高血压；脑出血；谵妄；高危因素；预后
　　[中图分类号] R619 [文献标识码] A [文章编号] 1674-4721（2019）4（b）-0178-04
　　[Abstract] Objective To investigate the risk factors and prognosis of postoperative delirium in patients with hypertensive intracerebralhemorrhage. Methods A total of 130 patients with hypertensive intracerebral hemorrhage who were treated in our hospital from May 2017 to August 2018 were selected as the research objects. The occurrence， risk factors and prognosis of delirium after hypertensive intracerebral hemorrhage were analyzed by self-designed questionnaire. Results A total of 130 patients， 37 patients showed postoperative delirium， the incidence of delirium was 28.46%. The results of univariate analysis indicated that there were statistically significant differences in age， blood loss， operation time， postoperative Glasgow coma index score （GCS）， mechanical ventilation and postoperative hypoxemia between patients with and without delirium hypertensive cerebral hemorrhage （P<0.05）. Multivariate Logistic analysis indicated that age （β=-0.854， OR=2.342， P<0.05）， blood loss （β=-0.752， OR=1.756， P<0.05）， operative time （β=-0.672， OR=1.526， P<0.05）， postoperative GCS score （β=-0.558， OR=3.514， P<0.05） and postoperative hypoxemia （β=-0.652， OR=4.514， P<0.05） were risk factors for postoperative delirium in patients with hypertensive intracerebral hemorrhage. Mechanical ventilation was the protective factor for postoperative delirium in patients with hypertensive intracerebral hemorrhage （β=0.614， OR=0.862， P<0.05）. Twenty-one patients survived 90 days after surgery for delirium hypertensive intracerebral hemorrhage， the survival rate was 56.76%， which was significantly lower than that of 81 patients without postoperative delirium hypertensive cerebral hemorrhage （87.10%）， and the difference was statistically significant （P<0.05）. Conclusion The occurrence of delirium after hypertensive intracerebral hemorrhage is influenced by many factors and is closely related to the survival rate of patients after operation.
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