先天性心脏病患儿术后谵妄发生现状及亚型分析

Investigation on status quo and subtypes of postoperative delirium in children with congenital heart disease

目的描述国内先天性心脏病患儿术后谵妄的发生现状及发生亚型情况。方法前瞻性观察2020年12月至2021年6月于中国医学科学院阜外医院完成先天性心脏病外科手术的患儿216例,术后根据康奈尔儿童谵妄评估量表(CAPD)评估结果,了解先天性心脏病患儿术后谵妄的发生现状及发生亚型情况。结果研究期间共114例占52.78%患儿发生了术后谵妄;谵妄开始时间以术后第1天居多,为58例占50.88%;在发生术后谵妄的患儿中,62例占54.39%患儿术后谵妄仅持续1 d。活动减少型、活动增多型和混合型3种术后谵妄亚型的发生率分别为35.09%(40/114)、29.82%(34/114)和35.09%(40/114),发生情况分布比较差异无统计学意义(χ^(2)=0.63,P>0.05);混合型术后谵妄开始时间显著晚于活动增多型术后谵妄(χ^(2)=7.07,P<0.05),而其持续时间显著长于活动减少型术后谵妄(χ^(2)=16.81,P<0.001)。将发生不同术后谵妄亚型的患儿的疾病相关因素进行两两比较,结果显示若患儿术中曾输血或手术难度较高,则该患儿发生活动减少型术后谵妄的概率较大(P<0.0167);若患儿术后发生中重度疼痛或评估期间肌松剂使用时间较短,则患儿更容易发生活动增多型术后谵妄(P<0.0167);而发生混合型术后谵妄的患儿气管插管时间、术后PICU住院时间以及总住院时间均为最长(P<0.0167)。结论术后谵妄在先天性心脏病患儿群体中发生率较高,且容易在术后早期发生,故早期识别和干预术后谵妄对于先天性心脏病患儿具有重要意义。不同特点的患儿易发生的术后谵妄类型存在一定差异,应引起关注。

Objective To describe the status quo and subtypes of postoperative delirium(POD)in children with congenital heart disease in China.Methods A total of 216 children with congenital heart disease who underwent surgery in Fuwai Hospital,Chinese Academy of Medical Sciences from December 2020 to June 2021 were prospectively observed.The status quo and subtypes of POD in children with congenital heart disease was evaluated according to the results of the Cornell assessment of pediatric delirium(CAPD).Results POD occurred in 114 children(52.78%)during the study period.The onset time of POD was most on the first postoperative day(50.88%).POD lasted only 1 day in 54.39%of the children who developed it.The incidence of POD subtypes(hyperactive delirium,hypoactive delirium,mixed delirium)were 35.09%,29.82%and 35.09%,respectively,and there was no significant difference in the incidence distribution among them(χ^(2)=0.63,P>0.05).The onset time of mixed delirium was significantly later than that of hyperactive delirium(χ^(2)=7.07,P<0.05),and the duration of mixed delirium was significantly longer than that of hypoactive delirium(χ^(2)=16.81,P<0.001).The results showed that if the child had blood transfusion during operation or the operation was difficult,the probability of reduced activity delirium after operation was higher(P<0.0167).Children wieth moderate to severe postoperative pain or short duration of muscle relaxant use during the evaluation period were more likely to have a hyperactive postoperative delirium.(P<0.0167).The time of tracheal intubation,the time of hospitalization after operation and the the postoperative time in PICU were the longest in the children with mixed type of postoperative delirium(P<0.0167).Conclusions POD has a high incidence in children with congenital heart disease,and it is more likely to occur in the early postoperative stage.Therefore,early postoperative identification and intervention of POD is of great significance for children with congenital heart disease.Children with different characteristics are prone to different types of POD,which should be paid attention to.