冠状动脉旁路移植术后谵妄的发生率和相关危险因素研究

Morbidity and related risk factors of postoperative delirium in the patients undergoing coronary artery bypass grafting

目的 探讨冠状动脉旁路移植术后谵妄的发生率和相关危险因素.方法 连续纳入2013年1-12月北京安贞医院心脏外科病房择期冠状动脉旁路移植手术患者286例,以《谵妄分级量表-98修订版》作为谵妄诊断工具,分析患者术后谵妄的发生率和危险因素.结果 （1）286例患者术后谵妄发生率为8.4％（24/286例）,其中66.7％（16/24例）谵妄持续时间＜24h,33.3％（8/24例）谵妄持续时间≥48 h.（2）常见的谵妄症状包括精神运动性兴奋、睡眠-觉醒周期紊乱和意识水平改变.（3）组间单因素分析显示年龄≥70岁（OR=3.05,95％ CI2.55 ～72.94,P=0.023）、既往脑梗死（OR =1.78,95％ CI 1.07 ～ 2.96,P=0.026）、既往脑出血（OR=1.99,95％ CI 1.20～3.31,P=0.003）、手术持续时间（OR=1.05,95％ CI 0.05～2.04,P=0.047）、使用芬太尼（OR =2.78,95％ CI1.02 ～7.57,P=0.045）、重症监护病房（ICU）观察时间（OR=2.87,95％ CI 1.43～5.72,P=0.003）与术后谵妄发生相关.（4） Logsistic多因素回归分析显示年龄≥70岁（OR=3.196,95％ CI1.574 ～6.488,P=0.001）、脑梗死（OR=2.610,95％ CI 1.538～4.431,P=0.000）、ICU观察时间（OR=1.480,95％ CI 1.070 ～2.046,P=0.018）是术后谵妄的危险因素.结论 冠状动脉旁路移植术后谵妄的发生率为8.4％,与年龄（≥70岁）、脑梗死以及ICU观察时间等多种因素有关,对于具有危险因素的患者,术前评估及提前处理可能减少术后谵妄的发生.

Objective To explore the morbidity and risk factors of postoperative delirium in the patients undergoing coronary artery bypass grafting （CABG）.Methods A total of 286 patients were continuously enrolled for CABG surgery from January to December 2013 in cardiac surgery ward in Beijing Anzhen Hospital.Delirium Rating Scale-Revised-98 was used as the diagnostic tool for the analysis of the morbidity and risk factors of postoperative delirium.Results （1） Delirium occurred in 24 patients of 286 patients and morbidity of postoperative delirium was 8.4%.Sixteen of 24 patients （66.7%） suffered from transient delirium （〈24 h）.Eight of 24 patients （33.3%） suffered from continuous delirium （≥48 h）.（2） The common clinical presentation of postoperative delirium included increased psychomotor activity, a disordered sleep-wake cycle and a reduced level of consciousness.（3） Univariate Logistic regression analysis results showed that delirium was associated with advanced age over 70 years old （OR =3.05, 95% CI 2.55-72.94, P =0.023）, previous cerebral infarction（OR =1.78, 95% CI 1.07-2.96, P =0.026）, previous brain heamorrhage （OR =1.99, 95 % CI 1.20-3.31, P =0.003）, surgery time （OR =1.05, 95% CI0.05-2.04, P =0.047）, intensive care unit （ICU） staying time （OR =2.87, 95% CI 1.43-5.72, P=0.003）, use offentanyl （OR=2.78, 95% CI 1.02-7.57, P=0.045）.（4） The multiple Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age over 70 years old （OR =3.196, 95% CI 1.574-6.488, P =0.001）, cerebrovascular accident history（OR =2.610, 95% CI 1.538-4.431, P =0.000） and ICU duration time（OR =1.480, 95 % CI 1.070-2.046, P =0.018）.Conclusions The morbidity of postoperative delirium after CABG is 8.4%.Many predisposing and precipitating factors contribute to postoperative delirium.These factors include age 〉 70 years, cerebral infarction and ICU staying time.Assessment and preventive strategies should be considered to reduce the incidence of delirium, particularly among those patients with high risks.