麻醉药物对心脏手术患者术后谵妄影响的研究

Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery

目的评估心脏手术中麻醉药物的选择(丙泊酚或吸入麻醉药物)与术后谵妄发生的关系。方法本研究为一项回顾性研究,筛选2018年10月至2019年3月于四川大学华西医院行择期体外循环下心脏手术成年患者。根据诱导后麻醉维持药物(包括体外循环期间),将患者分为丙泊酚组和吸入麻醉组。主要结局指标为术后3 d谵妄发生率。使用logistic回归分析来确定麻醉药物与术后谵妄发生的关系。结果共纳入197例符合纳入标准的受试患者,平均年龄53岁,女性占51.8%(102/197)。整体谵妄发生率为21.3%(42/197),丙泊酚组为21.4%(21/98),吸入麻醉组为21.2%(21/99),两组差异无统计学意义(RR=1.01,95%CI 0.51~2.00,P=0.970)。采用logistic回归模型校正相关混杂因素后,显示麻醉维持药物不是心脏手术术后谵妄发生的危险因素(OR=1.05,95%CI 0.48~2.32,P=0.900)。结论体外循环下心脏手术术中麻醉维持药物(丙泊酚或吸入麻醉药物)的选择不增加术后谵妄的发生风险。

Objective To determine whether there was a clinical relevant association between anesthetic regimen(propofol or inhalational anesthetics)and the occurrence of postoperative delirium(POD)in patients undergoing cardiac surgery.Methods This retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass(CPB)at West China Hospital of Sichuan University between October 2018 and March 2019.The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen(including CPB).The primary outcome was the occurrence of POD during first 3 days after surgery.Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.Results A total of 197 patients who met the inclusion criteria were included,with an average age of 53 years,and 51.8%(102/197)were females.POD occurred in 21.3%(42/197)patients.The incidence of POD was 21.4%in the propofol group and 21.2%in the inhalational anesthetics group;there was no significant difference between the two groups(RR=1.01,95%CI 0.51-2.00,P=0.970).Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors(OR=1.05,95%CI 0.48-2.32,P=0.900).Conclusion Anesthetic regimen(propofol or inhalational anesthetics)is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.