老年患者腰椎术后延迟神经认知恢复的危险因素分析

Risk factors for delayed neurocognitive recovery in elderly patients after lumbar spine surgery

摘要

目的 探讨老年患者腰椎手术术后延迟神经认知恢复（dNCR）的危险因素。方法 回顾性分析2023年12月-2025年12月于徐州市中心医院全身麻醉下行腰椎手术的376例老年患者的临床资料，根据是否发生dNCR将患者分为dNCR组（80例）与非dNCR组（296例）。采用SPSS软件与R软件进行数据分析及绘图。根据数据类型，分别采用t检验、Mann-Whitney U检验、χ²检验、Fisher确切概率法等进行组间比较。采用多因素Logistic回归方法分析老年患者腰椎术后dNCR发生的独立危险因素。结果 376例老年腰椎手术患者，术后第7 d的dNCR发生率为21.3%（80/376）。高龄（OR=1.133，95%CI：1.063~1.207，P=0.006）、术前低简易精神状态检查评分（OR=1.107，95%CI：1.019~1.203，P=0.013）、术前高查尔森合并症指数（OR=1.427，95%CI：1.112~1.831，P=0.005）、手术时间延长（OR=1.005，95%CI：1.001~1.009，P=0.009）、术后24 h高视觉模拟评分（OR=1.240，95%CI：1.045~1.471，P=0.013）、术后入重症监护室（OR=2.399，95%CI：1.218~4.725，P=0.018）、36℃曲线下面积升高（OR=1.008，95%CI：1.002~1.016，P=0.007）是老年患者腰椎术后发生dNCR的独立危险因素。该多因素Logistic回归模型对dNCR有良好的区分能力（AUC=0.917，95%CI：0.876~0.946），以及较高的拟合程度（Hosmer-Lemeshow拟合优度检验，χ²=6.825，P=0.556）。结论 临床可通过术前精准评估高危人群、严格控制基础疾病、术中精准体温管理、缩短手术时间、加强术后镇痛等针对性干预措施，降低dNCR的发生风险，改善患者术后康复结局。

Abstract

Objective To explore the risk factors for delayed neurocognitive recovery (dNCR) in elderly patients after lumbar spine surgery. Methods A retrospective analysis was conducted on the clinical data of 376 elderly patients who underwent lumbar spine surgery under general anesthesia at Xuzhou Central Hospital from December 2023 to December 2025. Patients were divided into the dNCR group (80 cases) and the non-dNCR group (296 cases) based on the occurrence of dNCR. SPSS software and R software were used for data analysis and visualization. Inter-group comparisons were performed using the t-test, Mann-Whitney U test, χ² test, Fisher's exact test, according to data types. Multivariate logistic regression analysis were used to identify the independent risk factors for dNCR in elderly patients after lumbar spine surgery. Results Among the 376 elderly patients undergoing lumbar spine surgery, the incidence of dNCR at 7 days postoperatively was 21.3% (80/376). Advanced age (OR=1.133, 95% CI: 1.063~1.207, P=0.006), low preoperative Mini-Mental State Examination (MMSE) score (OR=1.107, 95% CI: 1.019~1.203, P=0.013), high preoperative Charlson Comorbidity Index (CCI) (OR=1.427, 95% CI: 1.112~1.831, P=0.005), prolonged operation time (OR=1.005, 95% CI: 1.001~1.009, P=0.009), a high visual analogue scale (VAS) score at 24 h postoperatively (OR=1.240, 95% CI: 1.045~1.471, P=0.013), postoperative admission to the intensive care unit (ICU) (OR=2.399, 95% CI: 1.218~4.725, P=0.018), and elevated area under the curve at 36℃ (36℃ AUC) (OR=1.008, 95% CI: 1.002~1.016, P=0.007) were independent risk factors for dNCR in elderly patients after lumbar spine surgery. The multivariate logistic regression model showed good discriminative ability for dNCR (area under the curve [AUC]=0.917, 95% CI: 0.876~0.946) and high goodness of fit (Hosmer-Lemeshow test, χ²=6.825, P=0.556). Conclusion Clinically, targeted intervention measures such as preoperative accurate assessment of high-risk groups, strict control of underlying diseases, precise intraoperative temperature management, shortening of operation time, and enhancement of postoperative analgesia can reduce the risk of dNCR and improve the postoperative rehabilitation outcome of patients.

关键词

腰椎手术 / 延迟神经认知功能障碍 / 老年人 / 危险因素

Key words

Lumbar spine surgery / Delayed neurocognitive recovery / Aged / Risk factors

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基金资助

国家自然科学基金项目(81700078)

徐州市医学重点人才项目(XWRCHT20220051)

江苏省卫生健康委员会基金项目(M2024008)

江苏省新药研究与临床药学重点实验室项目(XZSYSKF2024020)