急性主动脉夹层患者术后谵妄现状、相关因素及干预措施

Postoperative Delirium Status,Related Factors,and Intervention Measures in Patients with Acute Aortic Dissection

目的探讨急性主动脉夹层患者术后谵妄现状、相关因素及干预措施。方法本文采取回顾性分析,选取河南省胸科医院心血管外科六病区2020年1月至2023年6月收治的急性A型主动脉夹层患者210例作为研究对象,其中男130例,女80例,以术后5 d内是否发生谵妄分为谵妄组和非谵妄组。收集汇总所有临床数据,以单因素logistic回归分析谵妄发生相关因素,以多因素logistic回归分析独立危险因素,并探讨预后情况。结果110例急性主动脉夹层患者中有32例患者术后发生谵妄,占比29.10%;单因素logistic回归分析显示,年龄、酗酒史、术前谷丙转氨酶水平、术后当天急性生理学与慢性健康状况评分系统Ⅱ评分、ICU 6 h内平均动脉压、ICU 6 h内局部脑氧饱和度为谵妄发生相关因素(P<0.05)。年龄增长、酗酒史、ICU 6 h内平均动脉压、ICU 6 h内局部脑氧饱和度为急性主动脉夹层患者术后谵妄发生独立危险因素(P<0.05)。与非谵妄组对比,谵妄组ICU内急性肾损伤、多器官功能障碍综合征发生率高,且停留时间明显延长(P<0.05)。结论年龄增长、长期酗酒史、ICU 6 h内平均动脉压和ICU 6 h内局部脑氧饱和度均为急性主动脉夹层术后发生谵妄的独立危险因素。

Objective Exploring the current status,related factors,and intervention measures of postoperative delirium in patients with acute aortic dissection.Methods This article adopted a retrospective analysis and selected 210 patients with acute type A aortic dissection admitted to the the Sixth Ward of Cardiovascular Surgery in Henan Chest Hospital from January 2020 to June 2023 as the research subjects,including 130 males and 80 females.Patients were divided into delirium group and non-delirium group based on whether delirium occurs within 5 days after surgery.All clinical data were collected and summarized,the factors related to delirium occurrence were analyzed using univariate logistic regression,independent risk factors were analyzed using multivariate logistic regression,and the prognosis was explored.Results Among 110 patients with acute aortic dissection,32 cases(29.10%)developed delirium after operation.Univariate logistic regression analysis showed that age,history of alcoholism,alanine transaminase level before surgery,acute physiology and chronic health evaluationⅡscore on the day after surgery,mean arterial pressure in ICU for 6 hours,and local cerebral oxygen saturation in ICU for 6 hours were the relevant factors for the occurrence of delirium(P<0.05).Aging,alcohol abuse history,mean arterial pressure in ICU for 6 hours,local cerebral oxygen saturation in ICU for 6 hours were independent risk factors for postoperative delirium in patients with acute aortic dissection(P<0.05).Compared with the non-delirium group,the incidence of acute kidney injury and multiple organ dysfunction syndrome in ICU in delirium group was higher,and the residence time was prolonged(P<0.05).Conclusion Aging,long history of alcoholism,mean arterial pressure in ICU for 6 hours and local cerebral oxygen saturation in ICU for 6 hours are independent risk factors for postoperative delirium in patients with acute aortic dissection.