永久起搏器植入术后谵妄的危险因素研究  

Incidence and risk factors of delirium in patients post permanent pacemaker implantation

作　　者：朱孔博[1] 叶行舟[1] 陈龙[1] 智宏[1] 任利群[1] 马根山[1] 

机构地区：[1]东南大学附属中大医院心内科,南京210009

出　　处：《中华心血管病杂志》2016年第4期338-341,共4页Chinese Journal of Cardiology

摘　　要：目的 探讨永久起搏器植入术后谵妄的危险因素.方法 入选2013年9月至2015年2月期间我院行永久起搏器植入术的患者,收集临床资料和实验室检查数据,术后当天及第1、2、3天用谵妄评定法进行谵妄评估.根据术后是否发生谵妄将患者分为术后谵妄组和对照组,通过单因素及多因素分析研究术后谵妄危险因素.结果 225例患者入选,术后谵妄组12例（5.3％）,对照组213例（94.7％）.与对照组比较,术后谵妄组年龄更高[（83±5）岁比（74±11）岁,P=0.002],术前血压显著异常者比例更高[58.3％ （7/12）比4.7％（10/213）,P＜0.001],收缩压较高[（157±35）mmHg比（136±22） mmHg,1 mmHg=0.133 kPa,P=0.007],低钠血症发生率较高[25.0％ （3/12）比5.2％ （11/213）,P=0.030],术前平均心率较慢[（47±18）次/min比（58±15）次/min,P=0.007].采用前进逐步法将年龄、术前血压显著异常、低钠血症、术前平均心率、陈旧性脑梗死作为自变量纳入logistic回归模型分析显示,高龄（OR=2.984,95％CI1.226 -7.624,P=0.016）、术前血压显著异常（OR=27.393,95％CI6.735 - 111.417,P＜0.001）与术后谵妄相关.结论 高龄和术前血压显著异常是永久起搏器植入术后谵妄的危险因素.Objective To evaluate the incidence and risk factors of postoperative delirium in patients post permanent pacemaker implantation.Methods Patients underwent permanent pacemaker implantation in our department from September 2013 to February 2015 were included in this study.Delirium was measured by the confusion assessment method on the first three postoperative days.All the patients were divided into the postoperative delirium group and the non-delirium control group according to whether new onset delirium was diagnosed.Risk factors significantly associated with postoperative delirium detected by univariate analysis were entered into multivariable analysis to define the independent predictors of postoperative delirium.Results A total of 225 patients were enrolled in this study.The incidence of postoperative delirium was 5.3%.Patients developing postoperative delirium were older （（83 ± 5） years vs.（74 ± 11） years,P =0.002）,had a significantly higher incidence of blood pressure fluctuations （58.3% （7/12） vs.4.7% （10/213）,P〈0.001）,hyponatremia （25.0% （3/12） vs.5.2% （11/213）,P=0.030） and had higher systolic blood pressure （（157 ± 35） mmHg vs.（136 ± 22） mmHg,1 mmHg =0.133 kPa,P =0.007）.However,patients developing postoperative delirium had lower preoperative average heart rate （（47 ± 18）bpm vs.（58 ± 15）bpm,P =0.007）.Muhiple regression analysis showed that advanced age （OR =2.984,95 % CI：1.226-7.624,P =0.016） and blood pressure fluctuations （OR =27.393,95% CI：6.735-111.417,P 〈0.001） are the independent risk factors for pacemaker patients with postoperative delirium.Conclusion Advanced age and blood pressure fluctuations are independent risk factors of postoperative delirium in patients post permanent pacemaker implantation.

关 键 词：心脏起搏器 人工 谵妄 

分 类 号：R54[医药卫生—心血管疾病]