睡眠障碍老年患者术后谵妄的发生情况及其 肠道菌群特征分析

Analysis of the Occurrence of Postoperative Delirium in Elderly Patients with Sleep Disorders and Their Intestinal Flora Characteristics

摘要: 目的：观察睡眠障碍老年患者术后谵妄的发生率及其肠道菌群特征分析。方法：选择骨科收治的睡眠障碍老年患者，拟行单侧髋或膝关节置换手术，根据术后是否发生术后谵妄(POD)分为：POD组(P组)和非POD组(N组)。记录患者围术期临床资料，采用16S rRNA基因测序技术测定术前粪便样本，并分析肠道菌群特征。结果：睡眠障碍老年患者行单侧髋或膝关节置换手术后，POD发生率为29.5%。与N组比较，P组患者年龄更高，而BMI更低。两组患者菌群Beta多样性存在明显差异。通过LEfSe分析进化分枝图发现，P组患者γ-变形菌纲、肠杆菌目、疣微菌科、肠杆菌科等丰度较高；N组患者β-变形菌门、拟杆菌纲、伯克霍尔德氏菌目、普雷沃菌科等丰度较高。与N组相比，P组厌氧菌相对丰度明显减少。结论：睡眠障碍与POD发生密切相关，术前睡眠障碍患者POD发生率较高。与未发生POD患者相比，其术前肠道菌群构成已有明显差异，这可能为预测POD的发生提供依据。

Abstract: Objective: To observe the incidence of postoperative delirium in elderly patients with sleep disorders and their intestinal flora characteristics. Method: Elderly patients with sleep disorders admitted to the orthopedic department and scheduled for unilateral hip or knee joint replacement surgery were selected. They were divided into two groups based on whether postoperative delirium (POD) occurred: the POD group (P group) and the non-POD group (N group). The perioperative clinical data of the patients were recorded, and the fecal samples before the operation were analyzed using 16S rRNA gene sequencing technology to determine the intestinal flora characteristics. Result: After unilateral hip or knee joint replacement surgery for elderly patients with sleep disorders, the incidence of POD was 29.5%. Compared with the N group, patients in the P group were older and had a lower BMI. There were significant differences in the Beta diversity of the microbiota between the two groups. The phylogenetic tree was drawn by LEfSe analysis, and it was found that Gammaproteobacteria, Enterobacteriales, Enterobacteriaceae, and Ruminococcaceae were more abundant in the P group, Betaproteobacteria, Bacteroidia, Burkholderiales, and Prevotellaceae were more abundant in the N group. Compared with the N group, the relative abundance of anaerobic bacteria was significantly reduced in the P group. Conclusion: Sleep disorders are closely related to POD, and the incidence of POD in patients with preoperative sleep disorders is higher. Compared with patients who did not experience POD, the composition of their preoperative intestinal flora showed significant differences, which may provide a basis for predicting the occurrence of POD.