ICU心脏手术患者术后谵妄发生现况及影响因素

Current situation and influencing factors of postoperative delirium in intensive care unit patients undergoing cardiac surgery

目的分析重症监护室(ICU)中心脏手术患者术后谵妄发生的现况及其影响因素,为防治术后谵妄(postoperative delirium,POD)提供理论依据。方法选取2021年12月至2022年3月心脏术后入住ICU的患者作为研究对象。以患者是否发生谵妄分为谵妄组和非谵妄组,比较2组患者的人口学资料和临床资料。采用单因素和多因素Logstic回归对可能的危险因素进行分析,并应用接受者操作特征(ROC)曲线全面分析各危险因素和联合预测模型对谵妄的预测效能。结果共180例患者被纳入本项研究,其中49例患者发生了谵妄,谵妄发生率为27.2%。经单因素和Logistic回归分析显示:APACHEⅡ评分、体外循环、身体约束、睡眠质量、机械通气时间是其独立危险因素,曲线下面积分别为0.626、0.612、0.624、0.652、0.769。其中,联合预测模型曲线下面积为0.802,敏感度/特异度为0.878/0.603,采用Hosmer-Lemeshow验证模型拟合效果(P=0.340)。结论ICU心脏手术患者术后谵妄的发生率高,临床应加强对高危人群的监测并尽早实施防治措施,以降低术后谵妄发生率,改善患者预后。

Objective To analyze the current situation and influencing factors of postoperative delirium(POD)in intensive care unit(ICU)patients undergoing cardiac surgery,aiming to provide theoretical basis for the prevention and treatment of POD.Methods The 180 ICU patients undergoing cardiac surgery from December 2021 to March 2022 were enrolled.The patients were allocated to delirium and non-delirium groups according to whether they developed delirium or not.The demographic and clinical data of the two groups were compared.Monofactor and multifactor logistic regression were used to analyze possible risk factors,and the receiving operating characteristic(ROC)curves were performed to analyze the prediction efficiency of each risk factor and combined predictors for delirium.Results Among 180 patients,49(49/180,27.2%)patients developed delirium.Logistic regression analysis showed that APACHEⅡscore,cardiopulmonary bypass,physical restraint,sleep quality,and mechanical ventilation time were independent risk factors,and the areas under the curve(AUC)were 0.626,0.612,0.624,0.652,0.769,respectively.The AUC of combined predictor was 0.802,and the sensitivity/specificity was 0.878/0.603.Hosmer-Lemeshow test was used to verify the model fitting effect(P=0.340).Conclusion The incidence of POD in ICU patients undergoing cardiac surgery is high.Clinical monitoring of high-risk groups should be strengthened,and preventive measures should be implemented as soon as possible to reduce the incidence of POD and improve the prognosis of patients.