心脏术后患者谵妄的危险因素分析

Analysis of Risk Factors of Delirium After Cardiac Surgery

目的探讨心脏术后患者谵妄的发生率及危险因素分析。方法观察南京市中医院120例患者围手术期指标,利用CAM-ICU量表评估患者是否发ICU谵妄,根据谵妄发生与否进行分组,对比两组患者的性别、年龄、合并症(高血压、糖尿病、房颤、慢性阻塞性肺疾病等)、手术时间、体外循环、术后疼痛、术后低氧、术后高碳酸血症等指标,根据单因素分析结果再进行多因素分析。结果谵妄患者共有31例,发生率为25.8%。单因素分析结果显示:年龄、术前房颤、手术时间、术后疼痛与术后谵妄有相关性,logistic回归分析显示年龄、手术时间及术后疼痛为术后谵妄发生的独立危险因素。结论老龄患者更易发生术后谵妄,缩短手术时间及术后有效镇痛可减少谵妄的发生。

Objective To analyze the incidence rate and the perioperative risk factors associated with delirium after cardiacsurgery. Methods Perioperative indicators of 120 patients were observed. The CAM-ICU scale was used to evaluate whether the pa-tients had delirium in the ICU. The patients were divided to two groups according to the occurrence of delirium. The gender, ageand comorbidities(hypertension, diabetes, atrial fibrillation and chronic obstructive pulmonary disease, etc), surgery time, cardiopul-monary bypass, postoperative pain, postoperative hypoxia and postoperative hypercapnia were compared. All perioperative indica-tors were recorded, and analyzed via univariate and multivariate logistic regression analysis to determine the risk factors of postoper-ative delirium. Results There were 31 patients with delirium, and the incidence rate was 25.8%. Univariate analysis showed thatthere were significant differences in age, preoperative atrial fibrillation, operation time, and postoperative pain between the deliriumgroup and the non-delirium group. Logistic regression analysis showed that age, operative time and postoperative pain were inde-pendent risk factors for postoperative delirium. Conclusion Older patients are more prone to postoperative delirium. Shorteningthe operation time and effective postoperative analgesia can reduce the occurrence of delirium.