Stanford A型主动脉夹层患者术后谵妄的危险因素分析

Research on the Risk Factors for Delirium of Stanford Type A Aortic Dissection Patients after Surgery

目的分析Stanford A型主动脉夹层患者术后谵妄的危险因素。方法回顾性分析广东省心血管病研究所2012年1月至2014年12月行手术治疗的A型主动脉夹层335例患者的临床资料,其中男280例、女55例,年龄（48.5±10.3）岁。根据患者术后是否出现谵妄,分为谵妄组与对照组,研究术后谵妄发生的独立危险因素。结果全组发生谵妄共169例,发生率为50.4%。单因素及logistic多因素分析结果显示,术前D二聚体水平（OR=2.480,95%CI 1.347-4.564,P〈0.01）、术中最低平均动脉压（OR=0.667,95%CI 0.612-0.727,P〈0.01）,术后机械通气时间（OR=2.771,95%CI 1.506-5.101,P〈0.01）,术后急性肾功能衰竭（OR=1.911,95%CI 1.065-3.430,P〈0.05）是Stanford A型主动脉夹层患者术后谵妄的独立危险因素。结论术后谵妄在Stanford A型主动脉夹层术后患者中有较高的发生率。术前D二聚体升高、术中平均动脉压过低、术后机械通气时间延长、合并急性肾功能衰竭的患者,术后谵妄的发生率明显升高。认识上述危险因素,积极干预可控因素,对减少术后谵妄的发生具有积极的意义。

Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery.Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014.There were 280 males and 55 females.The average of age was 48.5 ± 10.3 years.Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit（CAM-ICU）.The patients were divided into two groups including a delirium group and a control group.We tried to find the risk factors for postoperative delirium.Results There were 169 patients of delirium with a incident rate of 50.4 %.One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level（OR= 2.480,95 % CI 1.347-4.564,P 0.01）,the minimum mean arterial pressure during operation（OR= 0.667,95 % CI 0.612-0.727,P 0.01）,the postoperative ventilation time（OR= 2.771,95 % CI 1.506-5.101,P 0.01）and the postoperative acute kidney failure（OR= 1.911,95 % CI 1.065-3.430,P 0.05）were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery.Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high.Patients in this study with elevated pre-operative D-dimer level,lower intraoperative mean arterial pressure,longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium.Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.