冠状动脉旁路移植术后患者谵妄独立预测因子的现况分析

Predictors of delirium after coronary artery bypass graft surgery

目的找出能引起谵妄的独立危险因素,为建立一套适合我国国情的冠状动脉旁路移植术后患者谵妄风险预测模型提供依据。方法通过文献检索,收集现有的冠状动脉旁路移植术后谵妄风险预测模型中纳入的独立预测因子并进行分析。结果收集18个模型,共44个独立预测因子。年龄、简易精神状态评分是引起冠状动脉旁路移植术后谵妄发生的前2位独立预测因子,分别累计出现6次和4次。第3位的独立预测因子有6个,分别为血浆皮质醇浓度、手术时间、欧洲心血管手术危险因素评分、房颤、体外循环时间、糖尿病,分别累计出现3次。结论围术期冠状动脉旁路移植术谵妄预测因子众多,谵妄的临床表现复杂,如何在现有众多预测因子中筛查出特异性强、敏感度高的独立预测因子,是建立冠状动脉旁路移植术后谵妄风险预测理想模型的关键。

Objective To explore risk factors for delirium after coronary artery bypass graft surgery （CABG）, and to provide reference for developing delirium risk assessment tool. Methods Delirium risk assessment tools for CABG patients were retrieved through literatures and risk factors were analyzed. Results A total of 44 risk factors were identified in 18 tools. Age and Mini Men tal State Examination （MMSE） score were the first two risk factors, being reported in 6 and 4 tools. Serum cortisol level, duration of operation, European system for cardiac operative risk evaluation （Euro SCORE）, atrial fibrillation, cardiopulmonary bypass time, and diabetes mellitus ranked No. 3 on the list, being reported 3 times. Conclusion Several factors can predict delirium after CABG and clinical manifestation of delirium after CABG is complicated. Screening out specific and sensitive risk factors is the key to establish delirium risk assessment model after CABG.