体外循环下心血管手术患者术后谵妄发生情况及影响因素分析

周晨曦; 汪晖; 吴前胜; 周雁荣; 王兰; 王萧萧; 曾莹; 代玲; 张娜; 瞿茜

doi:10.12182/20230760105

体外循环下心血管手术患者术后谵妄发生情况及影响因素分析

Postoperative Delirium in Patients on Cardiopulmonary Bypass for Cardiovascular Surgeries: Incidence and Influencing Factors

摘要

摘要:
目的探索体外循环下心血管手术患者的术后谵妄（postoperative delirium, POD）与亚谵妄综合征（subsyndromal delirium, SSD）发生情况及影响因素。
方法收集2022年5–9月湖北省某三甲医院体外循环下心血管手术患者的一般资料、围手术期血常规及生理生化指标、手术及治疗情况等，采用护理谵妄筛查量表评估结局指标即POD和SSD发生情况，不同组别的影响因素分析采用无序多分类logistic回归。
结果 202例患者中，SSD、SSD进展为POD、直接发生POD的发生率为13.4%、6.4%、34.2%。回归分析显示，以无POD或SSD组为对照，术前血糖〔比值比（odds ratio, OR）=0.38，95%置信区间（CI）：0.19～0.76）〕、术中输注血小板（OR=0.37，95%CI：0.15～0.92）、术中依托咪酯剂量（OR=0.93，95%CI：0.87～0.98）、术后总胆红素水平（OR=1.04，95%CI：1.01～1.07）是SSD的影响因素；年龄（OR=1.09，95%CI：1.01～1.17）、ASA分级为Ⅳ级及以上（OR=10.72，95%CI：1.85～62.08）、术中右美托咪定剂量（OR=1.01，95%CI：1.003～1.02）、机械通气时长（OR=1.04，95%CI：1.01～1.07）是SSD进展为POD的影响因素；年龄（OR=1.06，95%CI：1.02～1.10）、初中或高中学历（OR=0.35，95%CI：0.15～0.83）、机械通气时长（OR=1.04，95%CI：1.01～1.07）是直接发生POD的影响因素。
结论年龄、受教育程度、ASA分级、术前血糖、术中输注血小板、术中依托咪酯剂量、术中右美托咪定剂量、术后总胆红素和机械通气时长是体外循环下心血管手术患者POD和SSD发生情况的影响因素，且不同组别的影响因素存在差异，应精准评估和干预不同组别的危险因素，预防或遏制POD或SSD的发生和发展，促进患者加速康复。

Abstract:
Objective To investigate the incidence and influencing factors of postoperative delirium (POD) and subsyndromal delirium (SSD) in patients connected to cardiopulmonary bypass during cardiovascular surgeries.
Methods We collected the general data and the data for the perioperative hematological, physiological, and biochemical indicators and the surgical and therapeutic conditions of patients connected to cardiopulmonary bypass during the course of cardiovascular surgeries conducted at a tertiary-care hospital in Hubei province between May 2022 and September 2022. The outcome indicators, including the incidence of POD and SSD, were assessed with the Nursing Delirium Screening Scale (Nu-DESC). Multinomial logistic regression was performed to analyze the influencing factors of patients with different statuses of POD and SSD.
Results Among the 202 patients, the incidence of SSD, SSD progressing to POD, and no POD or SSD (ND) progressing to POD were 13.4%, 6.4%, and 34.2%, respectively. Regression analysis showed that, with ND patients as the controls, the influencing factors for SSD were preoperative blood glucose (odds ratio OR=0.38, 95% confidence interval CI: 0.19-0.76), intraoperative platelet transfusion (OR=0.37, 95% CI: 0.15-0.92), intraoperative etomidate (OR=0.93, 95% CI: 0.87-0.98), and postoperative total bilirubin level (OR=1.04, 95% CI: 1.01-1.07). For the progression of SSD to POD, the influencing factors were age (OR=1.09, 95% CI: 1.01-1.17), ASA classification of IV and above (OR=10.72, 95% CI: 1.85-62.08), intraoperative dexmedetomidine (OR=1.01, 95% CI: 1.003-1.02), and the duration of mechanical ventilation (OR=1.04, 95% CI: 1.01-1.07). For the progression of ND to POD, the influencing factors were age (OR=1.06, 95% CI: 1.02-1.10), middle or high school education (OR=0.35, 95% CI: 0.15-0.83), and the duration of mechanical ventilation (OR=1.04, 95% CI: 1.01-1.07).
Conclusion Age, education, ASA classification, preoperative blood glucose, intraoperative platelet transfusion, intraoperative etomidate, intraoperative dexmedetomidine, postoperative total bilirubin, and the duration of mechanical ventilation are influencing factors for different statuses of POD and SSD among patients connected to cardiopulmonary bypass when they are undergoing cardiovascular surgeries. The influencing factors vary across groups of patients with different statuses of POD and SSD. Therefore, we should accurately assess the risk factors of patients with different statuses of POD and SSD and carry out corresponding interventions, thereby preventing or reducing the occurrence of POD and SSD, and ultimately promoting enhanced recovery after surgery.

HTML全文

参考文献(30)

施引文献

资源附件(0)