冠状动脉旁路移植术后气管插管拔除时间与谵妄发生的相关性

Effect of extubation time on delirium after coronary artery bypass grafting

目的评价气管插管拔除时间对体外循环冠状动脉旁路移植患者术(CABG)后谵妄的影响。方法回顾性分析阜外医院外科SICU2020年1月至12月行单纯行体外循环CABG的患者资料,包括基本情况、基础疾病、术前超声射血分数(EF)值、术前血肌酐值,术中体外循环时间及阻断时间,术后呼吸机使用时间,拔管时间、ICU停留时间以及术后谵妄发生率。结果共495例患者纳入研究,其中夜间拔管组54例,对照组441例。夜间拔管组患者年龄[(56.5±8.8)岁比(61.3±8.1)岁]、体外循环时间[(103.2±33.5)min比(126.2±47.2)min]、阻断时间[(75.0±28.3)min比(91.7±33.7)min]及呼吸机使用时间[(12.5±5.0)min比(18.6±12.9)min]均小于对照组,差异具有统计学意义(P<0.05)。夜间拔管组20例发生术后谵妄(37.0%),而对照组85例发生谵妄(20.5%),χ^(2)=9.082,P=0.004。多因素logistic回归分析结果夜间拔管为冠状动脉旁路移植术后谵妄的独立危险因素(OR=4.155,95%CI 2.118~8.151,P=0.001)。结论夜间拔管增加CABG后患者谵妄的发生率。

Objective To explore the effect of extubation on postoperative delirium in patients after CABG. Methods The information of patients underwent CABG with CPB from January 2020 to December 2020 was retrospectively analyzed. The patients’ general information, basic diseases, preoperative EF value, serum creatinine, CPB time and circulatory arrest time, ventilation time, extubation time, ICU days and the postoperative delirium incidence were recorded. Results A total of 495 patients were included in the study, 54 cases in the night extubation group and 441 cases in the control group. The night extubation group patients were younger than the control group [(56.5±8.8)years vs.(61.3±8.1) years] and had shorter CPB time [(103.2±33.5)min vs.(126.2±47.2)min], circulatory arrest time [(103.2 ± 33.5) min vs.(126.2 ± 47.2) min] and ventilation time [(12.5 ± 5.0) min vs.(18.6 ± 12.9) min], with statistical difference(P<0.05). In the night extubation group, postoperative delirium occurred in 20 cases(37.0%), while in the control group, delirium occurred in 85 cases(20.5%). The chi square value was 9.082, P=0.004. Multivariate logistic regression analysis showed that late night extubation was an independent risk factor for delirium after CABG(OR=4.155, 95%CI 2.118-8.151, P=0.001). Conclusion Night extubation would increase the incidence of delirium after CABG.