影响老年患者经皮冠状动脉介入术后谵妄的相关影响因素分析

Analysis of related factors affecting delirium in elderly patients after percutaneous coronary intervention

目的调查老年患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后谵妄的相关影响因素,为临床制定预防干预措施提供参考。方法选择2019年1月—2021年12月期间于复旦大学附属华东医院行PCI治疗的137例老年患者作为临床观察对象,通过重症监护意识模糊评估法(CAM-ICU)评估、统计谵妄发生率,采用临床资料调查量表,并经多因素二元Logistic回归分析法分析影响老年患者PCI术后谵妄的相关影响因素。结果137例行PCI治疗的老年患者中33例术后出现谵妄,术后谵妄发生率是24.09%;多因素二元Logistic回归分析结果显示,年龄>80岁、酗酒、独居、PCI手术操作时间>90 min、低钾血症、低氧血症、焦虑情绪、术后疼痛VAS评分≥7分、睡眠障碍等是影响老年患者PCI术后谵妄的独立影响因素(P<0.05)。结论老年患者PCI后谵妄发生风险较高,酗酒、独居、PCI手术操作时间>90 min、焦虑情绪、术后疼痛、睡眠障碍等因素是老年患者PCI术后谵妄发生的影响因素,临床医师可按照分析结果制定干预对策,以降低患者术后谵妄发生风险。

Objective To investigate the related influencing factors of delirium in elderly patients after percutaneous coronary intervention(PCI),and provide references for the formulation of clinical preventive intervention measures.Methods 137 cases of elderly patients who underwent PCI in Huadong Hospital Affiliated to Fudan University from January 2019 to December 2021 were selected as clinical observation subjects.The incidence of delirium was evaluated and counted by the Confusion Assessment Method for Intensive Care(CAM-ICU).The clinical data survey scale and multivariate logistic regression analysis were used to analyze the influencing factors of delirium after PCI in elderly patients.Results Among the 137 elderly patients who underwent PCI,33 had postoperative delirium,and the incidence of postoperative delirium was 24.09%.Multivariate binary logistic regression analysis showed that age>80 years old,alcoholism,living alone,PCI operation time>90 min,hypokalemia,hypoxemia,anxiety,postoperative pain VAS score≥7,sleep disorders and other factors were independent factors affecting delirium after PCI in elderly patients(P<0.05).Conclusion The risk of delirium in elderly patients after PCI is higher.Alcoholism,living alone,PCI operation time>90 minutes,anxiety,postoperative pain,sleep disturbance and other factors are the influencing factors of delirium in elderly patients after PCI.Clinicians can formulate intervention strategies according to this analysis results to reduce the risk of postoperative delirium.