心脏外科手术患者术后谵妄的发生率及其可干预危险因素:一项基于倾向性评分匹配的前瞻性观察研究

Incidence and modifiable risk factors of postoperative delirium in patients undergoing cardiac surgery:a prospective observational study based on propensity score matching

目的 探讨心脏外科手术患者术后谵妄(POD)的发生率及可干预危险因素。方法 采用前瞻性观察方法,连续纳入重庆医科大学附属第一医院心脏大血管外科2022年1月-2023年6月收治的880例心脏外科手术患者作为研究对象。记录所有患者的一般资料及临床特征,采用重症监护病房(ICU)意识模糊评分法(CAM-ICU)于患者入住ICU的第2天起进行2次/d的POD评估,转出ICU后停止随访观察。按照是否发生POD分为两组,计算POD的发生率,对两组患者进行1∶1倾向性评分匹配(PSM),比较两组患者PSM前后一般资料及临床特征的差异,采用logistic回归模型分析经PSM后心脏外科手术患者发生POD的可干预危险因素。结果 880例心脏外科手术患者中,有278例入住ICU期间发生了POD,发生率为31.6%,发生时间在入住ICU后的第2~12天,其中,254例(91.4%)发生于入住ICU的第2~6天。单因素分析显示,与POD相关的术前因素有性别、年龄、高血压、糖尿病、吸烟史,与POD相关的术中因素有ASA麻醉分级、手术时间、体外循环时间、主动脉阻断时间,与POD相关的术后因素有ICU入住时间、机械通气时间、VAS评分(P<0.05)。经PSM后,性别、年龄、血型3个人口学因素,在组间分布趋于一致(P>0.05);进一步多因素logistics回归分析显示,手术时间、ICU入住时间、机械通气时间、VAS评分是心脏外科手术患者发生POD的独立可干预危险因素(OR值分别为1.003、3.117、1.385、1.590,P<0.05)。结论 手术时间、ICU入住时间、机械通气时间、VAS评分是心脏外科手术后患者POD发生的可干预独立危险因素。因此,应根据病情特点结合危险因素进行早期干预,以进一步减少POD的发生。

Objective To investigate incidence and modifiable risk factors of postoperative delirium(POD)in patients undergoing cardiac surgery.Methods A prospective observational research method was conducted on 880 cardiac surgery patients admitted to the Department of Cardiovascular Surgery,at the First Affiliated Hospital of Chongqing Medical University from January 2022 to June 2023.Patients'general and clinical data were collected.POD was assessed twice daily from the second day in the ICU using the Confusion Assessment Method of Intensive Care Unit(CAM-ICU)until discharge or transfer from ICU.The patients were divided into two groups based on the presence of POD,and the incidence rate was calculated.Subsequently,a 1:1 propensity score matching(PSM)was applied between the two groups.The differences in general information and clinical characteristics between the two groups of patients before and after PSM were compared.Logistic regression analysis was used to evaluate the modifiable risk factors for POD in patients undergoing cardiac surgery after PSM.Results Of the 880 patients,278 experienced POD during their stay in the ICU,with an incidence rate of 31.6%.POD occurred between the 2nd and 12th day following ICU admission,with 91.4%(254 patients)experiencing it between the 2nd and 6th day.Univariate analysis identified preoperative factors of POD including gender,age,history of hypertension,history of diabetes,and smoking history;Intraoperative factors were ASA anesthesia grade,operation duration,extracorporeal circulation time,and aortic occlusion time;Postoperative factors included ICU length of stay,mechanical ventilation duration,and VAS score,all of which were statistically significant(P<0.05).After PSM,the distribution of three immutable demographic factors including gender,age,and blood type tended to be consistent among groups(P>0.05).Further multivariate logistic regression analysis showed that surgical time,ICU stay time,mechanical ventilation time,and VAS score were independent modifiable risk factors for POD in cardiac surgery patients(P<0.05),with corresponding OR values of 1.003,3.117,1.385,and 1.590,respectively.Conclusions Surgical time,ICU stay time,mechanical ventilation time,and VAS score are independent modifiable risk factors for the occurrence of POD in patients undergoing cardiac surgery.In clinical work,early intervention should be carried out based on the characteristics of the patient's condition and risk factors to further reduce the occurrence of POD.