术前身体活动能力与心脏外科术后谵妄的相关性研究

Study on the Relationship between Preoperative Physical Performance and Postoperative Delirium Undergoing Cardiac Surgery

目的:分析心脏外科手术患者术前身体活动能力与术后谵妄的相关性。方法:2019年9月-2020年1月在天津市某三级甲等心血管专科医院,连续收集择期心脏外科手术患者208例。心脏手术后5 d内,采用ICU意识模糊评估法(CAM-ICU)对所有入组的患者进行术后谵妄的评估,根据是否发生术后谵妄将患者分为谵妄组(n=55)与非谵妄组(n=153)。分析术前身体活动能力[握力、步行速度和计时起立-行走测试(TUGT)]与心脏术后谵妄的相关性,绘制TUGT预测术后谵妄发生的ROC曲线。结果:谵妄组与非谵妄组的年龄、性别、文化程度、血红蛋白、握力、步行速度、TUGT比较,差异均有统计学意义(P<0.05)。谵妄天数和术前握力、步行速度均呈负相关,与TUGT呈正相关(P<0.05)。多因素logistic回归分析,TUGT是心脏外科术后谵妄的独立影响因素(P=0.045)。结论:心脏外科手术患者的术后谵妄发生率随着TUGT测试所用时间的增加而升高,TUGT测试所用时间对此类患者术后谵妄的发生有较高的预测价值。

Objective:To analyze the relationship between preoperative physical performance and postoperative delirium undergoing cardiac surgery.Method:A total of 208 consecutive patients undergoing elective cardiac surgery in a cardiovascular tertiary hospital in Tianjin from September 2019 to January 2020.Within 5 d after cardiac surgery,all enrolled patients were assessed for postoperative delirium by CAM-ICU,and patients were divided into delirium group (n=55) and non-delirium group (n=153) according to whether postoperative delirium occurred.The correlation between preoperative physical activity[grip strength,walking speed,and timed stand-up walking test (TUGT)]and postoperative delirium was analyzed,and the ROC curve of TUGT predicting postoperative delirium was plotted.Result:The differences in age,gender,educational level,hemoglobin,grip strength,walking speed and TUGT between the delirium group and the non-delirium group were statistically significant (P<0.05).The number of days of delirium was negatively correlated with preoperative grip strength and walking speed,and positively correlated with TUGT (P<0.05).Multivariate logistic regression analysis showed that TUGT was an independent risk factor for postoperative delirium after cardiac surgery (P=0.045).Conclusion:The incidence of postoperative delirium in patients undergoing cardiac surgery is increasing with the increase of TUGT test time,which has a high predictive value for the occurrence of postoperative delirium in such patients.