高钠血症增加心脏手术后晚发谵妄的发生率  

Hypernatremia increases the incidence of late delirium after cardiac surgery

作　　者：洪亮[1] 沈骁 舒畅 施乾坤[1] 穆心苇[1] 章淬[1] HONG Liang;SHEN Xiao;SHU Chang;SHI Qiankun;MU Xinwei;ZHANG Cui(Department of Intensive Care Unit,Nanjing First Hospital,Nanjing Medical University,Nanjing,210006,P.R.China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)重症医学科,南京210006

出　　处：《中国胸心血管外科临床杂志》2020年第11期1320-1325,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：南京市卫生科技发展项目(YKK18108)。

摘　　要：目的分析心脏手术后48 h内出现高钠血症是否会增加患者手术48 h后出现谵妄(晚发谵妄)的概率。方法回顾性分析2016年5月至2019年5月在南京市第一医院心胸血管外科行心脏手术3365例患者的临床资料,其中男1918例、女1447例,年龄18~94(60.53±11.50)岁。结果共有155例患者出现晚发谵妄,占比4.61%。高钠血症患者晚发谵妄发生率9.77%,非高钠血症患者晚发谵妄发生率3.45%,差异有统计学意义(P<0.001)。心脏手术后48 h内出现高钠血症与晚发谵妄相关性的比值比(OR)=3.028(95%CI 2.155~4.224,P<0.001),纳入晚发谵妄的其它危险因素(包括老年、脑血管疾病史、手术时间、体外循环时间、乳酸、血红蛋白≥100 g/L、机械通气时间延长、左心室收缩功能、应用肾上腺素、应用去甲肾上腺素)后的矫正比值比(aOR)为1.524(95%CI 1.031~2.231,P=0.032)。结论心脏手术后48 h内出现高钠血症增加患者后期出现谵妄的风险。Objective To analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery(late-onset delirium).Methods We conducted a retrospective analysis of 3365 patients,including 1918 males and 1447 females,aged 18-94(60.53±11.50)years,who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019.Results A total of 155 patients developed late-onset delirium,accounting for 4.61%.The incidence of late-onset delirium in patients with hypernatremia was 9.77%,the incidence of late onset delirium in patients without hypernatremia was 3.45%,and the difference was statistically different(P<0.001).The odds ratio(OR)of hypernatremia was 3.028(95%confidence interval:2.155-4.224,P<0.001).The OR adjusted for other risk factors including elderly patients,previous history of cerebrovascular disease,operation time,cardiopulmonary bypass time,lactate,hemoglobin≥100 g/L,prolonged mechanical ventilation,left ventricular systolic function,use of epinephrine,use of norepinephrine was 1.524(95%confidence interval:1.031-2.231,P=0.032).Conclusion Hypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.

关 键 词：心脏手术 高钠血症 术后谵妄 

分 类 号：R654.2[医药卫生—外科学]