急性Stanford A型夹层术后谵妄的危险因素分析

Analysis of risk factors of postoperative delirium in patients with acute Stanford type A dissection

目的分析急性Stanford A型夹层术后谵妄的危险因素。方法回顾分析本院2014年5月至2019年5月手术的152例急性Stanford A型夹层患者,根据术后是否谵妄分为两组,A组(n=97)为非谵妄组,B组(n=55)为谵妄组。对两组患者围术期一般情况和术前化验指标进行单因素分析。对结果有差异的因素进行Logistic多因素回归分析。对术后3 d化验指标进行重复测量资料方差分析。结果根据单因素分析,体外循环和主动脉阻断时间、术中出血量、术后带管和ICU停留时间、术前白细胞和总胆红素在两组之间差异有统计学意义(P<0.05)。根据Logistic多因素回归分析,ICU停留时间、术前白细胞和总胆红素是急性Stanford A型夹层术后谵妄的独立危险因素。根据重复测量资料方差分析,术后血小板计数、肌酐、白蛋白和术后谵妄相关。结论ICU停留时间、术前白细胞和总胆红素是急性Stanford A型夹层患者术后谵妄的独立危险因素,术后血小板计数、肌酐、白蛋白和术后谵妄相关。

Objective To analyze the risk factors of postoperative delirium(POD)in patients with acute Stanford type A dissection.Methods A total of 152 patients with acute Stanford type A dissection operated in our hospital from May 2014 to May 2019 were divided into non-delirium group(group A)(n=97)and delirium group(group B)(n=55)according to whether delirium.The perioperative clinical data and preoperative laboratory indexes of the two groups were analyzed by univariate analysis.The factors with differences in univariate analysis were analyzed by logistic multivariate regression analysis.The repeated measurement data was analyzed by the analysis of variance of repeated measurement data three days after operation.Results According to univariate analysis,there were significant differences in cardiopulmonary bypass time,aortic clamping time,intraoperative blood loss,postoperative catheterization time,ICU residence time,preoperative white blood cell count and preoperative total bilirubin between the two groups.According to logistic multivariate regression analysis,ICU residence time,preoperative white blood cell count and preoperative total bilirubin were independent risk factors for postoperative delirium in patients with acute Stanford type A dissection.According to the analysis of variance of repeated measurement data,postoperative platelet count,creatinine,albumin and postoperative delirium were correlated.Conclusion Many perioperative factors are associated with postoperative delirium,among which preoperative leukocyte count,total bilirubin and ICU residence time are independent risk factors for postoperative delirium in patients with acute Stanford type A dissection.Postoperative platelet count,creatinine,albumin and postoperative delirium were associated.