冠状动脉旁路移植术后谵妄危险因素分析

Analysis of risk factors for delirium after coronary artery bypass grafting

目的了解冠状动脉旁路移植术(CABG)术后谵妄发生现状,分析危险因素并评价其预测效能。方法采用ICU患者意识模糊评估法(CAM-ICU)评估CABG术后314例患者谵妄发生情况。经多元Logistic回归分析,确定CABG术后谵妄危险因素。结果术后谵妄发生率为24.8%(78/314)。训练集谵妄发生率为25.7%(54/210),验证集谵妄发生率为23.1%(24/104)。经多元Logistic回归分析,美国麻醉医师物理状态、体外循环、简易智能精神状态量表、机械通气时间、术后咪达唑仑应用,血清白蛋白<30 g/L是CABG术后谵妄独立危险因素。在训练集和验证集中,谵妄得分>2.11分的患者为高危组,谵妄得分≤2.11分的患者为低危组。结论建立的谵妄模型可以将患者谵妄风险进行分层,同时也为术后谵妄预防与早期筛查提供临床科学依据。

Objective To investigate the incidence and risk factors of delirium after coronary artery bypass grafting(CABG)and evaluate the predictive efficacy of these risk factors.Methods The Confusion Assessment Method for the Intensive Care Unit(CAM-ICU)was used to evaluate the incidence of delirium in 314 CABG patients.Multivariate Logsictic regression analysis was used to determine the independent risk factors for delirium after CABG.Results The incidence of delirium after CABG was 24.8%(78/314).The incidence of delirium after CABG was 25.7%(54/210)in the training set,and 23.1%(24/104)in the validation set.American Society of Anesthesiologists Physical State≥4 points,cardiopulmonary bypass,Mini-Mental State Examination<27 points,mechanical ventilation time,postoperative midazolam application,and serum albumin<30 g/L were independent risk factors for delirium after CABG.In the training set and validation set,patients with delirium score>2.11 were in highrisk groups,and patients with delirium score≤2.11 were in low-risk groups.Conclusions The established delirium predictive model can not only stratify the risk of delirium,but also provide clinical scientific basis for postoperative delirium prevention and early screening.