心脏瓣膜术后患者谵妄与围术期心功能的相关性研究

Analysis of the association between postoperative delirium and perioperative cardiac function in patients undergoing cardiac valve surgery

目的:分析心脏瓣膜术后患者谵妄发生的影响因素以及术后谵妄与心功能的相关性。方法:选取2021年10月至2022年12月于安贞医院行心脏瓣膜手术的患者300例,收集患者术前及术后经胸心脏超声检查结果、术后血管活性药物使用情况及临床相关资料。结果:284名患者最终纳入分析,其中88例患者发生了术后谵妄(31.0%),经多因素Logistic回归分析结果显示,年龄(OR=1.085,P=0.048)、术前简易精神状态检查量表评分(OR=0.615,P=0.004)、术前EF值(OR=0.865,P=0.02)、麻醉时间(OR=1.687,P=0.045)、术后机械通气时间(OR=2.17,P=0.01)、住院天数(OR=1.378,P=0.043)、ICU天数(OR=1.699,P=0.018)和手术后前3d平均血管活性药物指数(OR=2.206,P=0.006)是心脏瓣膜手术患者术后谵妄发生的相关因素。结论:心脏瓣膜手术术后谵妄发生的影响因素较复杂,患者年龄、术前认知功能、麻醉时间、机械通气时间、术后ICU时间、住院时间和围术期心功能是术后谵妄的相关因素。重视和规避这些因素对改善患者术后转归有重要意义。

Objective:This study analyzes the influencing factors of postoperative delirium in patients undergoing heart valve surgery and the correlation between postoperative delirium and cardiac function.Methods:A total of 300 patients who underwent heart valve surgery in Anzhen Hospital from October 2021 to December 2022 were selected,and the results of transthoracic echocardiography before and after operation,the use of vasoactive drugs after operation and clinical related data were collected.Results:Of the 284 patients remaining for analysis,88 patients developed delirium,using Logistic regression models,age(OR=1.085,P=0.048),pre-operation lower MMSE score(OR=0.615,P=0.004),pre-operation lower EF(OR=0.865,P=0.02),longer anesthetic time(OR=1.687,P=0.045),post-operation longer mechanical ventilation time(OR=2.17,P=0.01),duration of hospital stay(OR=1.378,P=0.043),duration of ICU stay(OR=1.699,P=0.018),mean vasoactive inotropic score recorded on first 3 days after surgery(OR=2.206,P=0.006)were independently associated with delirium.Postoperative heart disfunction was associated with delirium.Conclusions:The influencing factors of postoperative delirium after heart valve surgery are complicated.The elderly patients,low preoperative MMSE score and low EF value are the predisposing factors of postoperative delirium,and the anesthesia time,mechanical ventilation time,postoperative ICU time,longer hospital stay and the use of large doses of vasoactive drugs are the precipitating factors.Paying attention to and avoiding these risk factors is of great significance to improve the postoperative prognosis of patients.