天津医药

天津医药 ›› 2026, Vol. 54 ›› Issue (3): 259-264.doi: 10.11958/20253057

• 临床研究 • 上一篇    下一篇

全麻下腹腔镜胃癌根治术后谵妄发生的危险因素分析

赵丽(), 马秀丽, 刘毅, 朱毅△()   

  1. 山西省肿瘤医院麻醉科（邮编030013）
  • 收稿日期:2025-09-28 修回日期:2025-11-26 出版日期:2026-03-15 发布日期:2026-03-17
  • 通讯作者: E-mail：zhuyi821014@163.com
  • 作者简介:赵丽（1984），女，主治医师，主要从事临床麻醉方面研究。E-mail：zhulili8411@sina.com
  • 基金资助:
    山西省科技合作交流专项项目(202204041101025)

Analysis of risk factors and predictive value of delirium occurrence after laparoscopic radical gastrectomy under general anesthesia

ZHAO Li(), MA Xiuli, LIU Yi, ZHU Yi△()   

  1. Department of Anesthesiology, Shanxi Cancer Hospital, Taiyuan 030013, China
  • Received:2025-09-28 Revised:2025-11-26 Published:2026-03-15 Online:2026-03-17
  • Contact: E-mail：zhuyi821014@163.com

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摘要：

目的 探讨全身麻醉（全麻）下接受腹腔镜胃癌根治术患者术后谵妄（POD）发生的独立危险因素，并评估多指标联合预测效能。方法 连续纳入行全麻腹腔镜胃癌根治术的310例患者并根据是否发生POD分为POD组（78例）和非POD组（232例）。通过单因素分析和多因素Logistic回归分析筛选POD发生的影响因素。采用受试者工作特征（ROC）曲线分析各影响因素的预测价值，计算曲线下面积（AUC），并对多因素联合预测效能进行评估。结果 与非POD组相比，POD组年龄较大、CO2气腹压升高、术中低氧血症和低血压发生比例升高、睡眠干扰比例升高、麻醉过深比例升高，血红蛋白水平下降（P<0.05）。多因素Logistic回归分析结果显示，高龄（OR=1.112，95%CI：1.040~1.188）、CO2气腹压升高（OR=10.967，95%CI：4.580~16.260）、术中低氧血症（OR=15.243，95%CI：5.564~20.676）、术中低血压（OR=12.481，95%CI：2.812~25.388）、睡眠干扰（OR=8.166，95%CI：2.530~26.352）和麻醉过深（OR=3.320，95%CI：1.135~9.645）是影响POD的独立危险因素，血红蛋白升高（OR=0.738，95%CI：0.652~0.834）是保护因素（P<0.05）。根据上述7种影响因素的特征进行分类，分为基础生理（年龄联合血红蛋白），术中生理异常（术中低氧血症、术中低血压和CO2气腹压升高），干预相关（麻醉过深和睡眠干扰），其诊断效能由高到低分别是术中生理异常（AUC=0.945，95%CI：0.908~0.968）、基础生理（AUC=0.892，95%CI：0.838~0.926）和干预相关（AUC=0.769，95%CI：0.713~0.838）。结论 基于POD的危险因素分层评估有助于早期识别POD，为临床干预提供循证依据。

关键词: 胃肿瘤, 腹腔镜检查, 麻醉, 全身, 谵妄, 影响因素分析

Abstract:

Objective To investigate the independent risk factors for postoperative delirium (POD) in patients undergoing laparoscopic radical gastrectomy under general anesthesia, and to construct a multifactorial combined prediction model to evaluate its diagnostic performance. Methods A total of 310 patients who underwent laparoscopic radical gastrectomy under general anesthesia were consecutively enrolled and divided into the POD group (n=78) and the non-POD group (n=232) according to whether POD occurred. Univariate analysis and multivariate Logistic regression analysis were used to screen for factors influencing POD. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor, and the area under the curve (AUC) was calculated. The predictive performance of the multifactorial combined model was also compared and assessed. Results Compared with the non-POD group, patients in the POD group were older, had higher CO2 pneumoperitoneum pressure, higher incidence of intraoperative hypoxemia and hypotension, higher proportion of sleep disturbance, higher proportion of excessively deep anesthesia and lower hemoglobin levels (all P<0.05). Multivariate Logistic regression analysis showed that advanced age (OR=1.112, 95%CI: 1.040-1.188), excessively high CO2 pneumoperitoneum pressure (OR=10.967, 95%CI: 4.580-16.260), intraoperative hypoxemia (OR=15.243, 95%CI: 5.564-20.676), intraoperative hypotension (OR=12.481, 95%CI: 2.812-25.388), sleep disturbance (OR =8.166, 95%CI: 2.530-26.352) and excessively deep anesthesia (OR =3.320, 95%CI: 1.135-9.645) were independent risk factors for POD, whereas higher hemoglobin level was a protective factor (OR =0.738, 95%CI: 0.652-0.834) (all P<0.05). According to the characteristics of these seven factors, patients were categorized into three groups: baseline physiological factors (age + hemoglobin), intraoperative physiological abnormalities (intraoperative hypoxemia + intraoperative hypotension+ CO2 pneumoperitoneum pressure) and intervention-related factors (excessively deep anesthesia + sleep disturbance). The diagnostic performance ranked as follows: intraoperative physiological abnormalities (AUC=0.945, 95%CI: 0.908-0.968), baseline physiological factors (AUC=0.892, 95%CI: 0.838-0.926) and intervention-related factors (AUC=0.769, 95%CI: 0.713-0.838). Conclusion Stratified assessment of risk factors based on POD is helpful for the early identification of POD and provides evidence-based guidance for clinical interventions.

Key words: stomach neoplasms, laparoscopy, anesthesia, general, delirious speech, root cause analysis

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