胸外科手术患者发生术中低血压与术后谵妄的关系:一项回顾性队列研究

The association between intraoperative hypotension and postoperative delirium in thoracic surgery patients:a retrospective cohort study

目的探讨术中低血压定义为平均动脉压小于60 mmHg时与术后谵妄的相关性,为临床提供参考。方法本研究为一项回顾性队列研究,纳入2020年12月至2021年11月于四川大学华西医院接受胸外科手术患者508例。收集患者数据资料包括:一般情况、术前睡眠评分、术前认知功能、手术相关资料、集束化干预策略、术后去向、是否术后谵妄、术中血压数据等。采用二元Logistic回归、多元Logistic回归、亚组分析等进行统计分析。结果本研究发现术中低血压不直接影响术后谵妄发生率。亚组分析结果显示,出现过术中低血压的术后谵妄患者更倾向于表现为抑郁型谵妄。吸烟者和未采取集束化干预策略者发生术中低血压后更易术后谵妄。患者高龄、术前睡眠差及开胸手术是发生术后谵妄的独立危险因素。结论患者术中低血压与术后谵妄的发生无直接关联,但当患者存在其他谵妄危险因素时,术中低血压的影响可能会被放大。对术中平均动脉压至少有1次<60 mmHg的患者,术后应更多地关注患者认知功能,以及时识别临床表现不明显的抑郁型谵妄。

Objective To explore the correlation between intraoperative hypotension defined as mean arterial pressure less than 60 mmHg and postoperative delirium,to provide clinical reference.Methods This study was a retrospective cohort study.A total of 508 patients who underwent thoracic surgery in West China Hospital of Sichuan University from December 2020 to November 2021 were included.The data of patients included:general condition,preoperative sleep score,preoperative cognitive function,surgery-related data,cluster intervention strategy,postoperative destination,postoperative delirium,intraoperative blood pressure data,etc.Binary Logistic regression,multiple Logistic regression and subgroup analysis were used for statistical analysis.Results This study found that intraoperative hypotension did not directly affect the incidence of postoperative delirium.Subgroup analysis showed that postoperative delirium patients with intraoperative hypotension were more likely to present with depressive delirium.Smokers and patients without cluster intervention strategies are more likely to have postoperative delirium after intraoperative hypotension.Advanced age,poor preoperative sleep and thoracotomy are independent risk factors for postoperative delirium.Conclusion There is no direct correlation between intraoperative hypotension and postoperative delirium,but the effect of intraoperative hypotension may be amplified when the patient has other risk factors for delirium.For patients with mean arterial pressure<60 mmHg at least once during operation,more attention should be paid to the cognitive function of patients after operation,and the depressive delirium without obvious clinical manifestations should be identified in time.