体外循环对冠状动脉旁路移植术后谵妄的影响  

Delirium after on-pump or off-pump coronary artery bypass grafting

作　　者：裴锋博[1] 卫金花[1] 程兆晶 凤玮[1] 潘世伟[1] 陈祖君[1] 郑哲[1] PEI Feng-bo;WEI Jin-hua;CHENG Zhao-jing;FENG Wei;PAN Shi-wei;CHEN Zu-jun;ZHENG Zhe(SICU Chinese Academy of medicai sciences and Peking Union Medical College,Fuwai Hospital,National Center for Cardiovescular Diseases)

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院成人外科恢复室

出　　处：《中国心血管病研究》2021年第8期718-721,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的比较体外与非体外循环冠状动脉旁路移植术(CABG)对患者术后谵妄发生率的影响。方法回顾性分析阜外医院外科重症监护室(SICU)2020年1月至2021年4月收治的单纯行CABG患者信息,根据手术方式分为体外循环组和非体外循环组。比较两组患者的基本资料、基础疾病,术前超声射血分数(EF)值和术前血肌酐水平。终点指标为两组患者住院期间的谵妄发生率。结果共607例患者纳入本研究,其中体外循环组495例,非体外循环组112例。两组患者年龄、性别比例、基础疾病(高血压、糖尿病、既往卒中史)、术前最后一次EF值、术前血肌酐值均无统计学差异。术中平均搭桥个数两组无统计学差异,体外循环组平均转机时间(123.7±46.8)min,主动脉阻断(89.9±33.6)min。术后呼吸机使用时间两组无统计学差异。ICU停留时间体外循环组高于非体外组[(3.0±1.8)d比(2.5±1.7)d,t=2.603,P=0.009]。术后主要不良心脑血管事件(MACCE)发生率及连续性肾脏替代治疗(CRRT)两组均无统计学差异。体外循环组105例患者发生谵妄(21.2%),非体外循环组14例发生术后谵妄(12.5%)。基于倾向性评分的逆概率加权回归分析提示OR值为2.402(95%CI:1.337~4.317),P=0.004。结论非体外循环冠状动脉旁路移植术可降低术后患者谵妄的发生率。Objective To evaluate the effect of on-pump and off-pump CABG on the incidence of postoperative delirium.Methods The information of patients with isolated CABG from January 2020 to April 2021 in Fuwai Hospital SICU were reviewed.The patients were divided into on-pump group and off-pump group according to the surgical method.The data including basic diseases,preoperative cardiac function,and creatinine values were collected.The endpoint was the incidence of delirium during hospitalization in both groups.Results A total of 607 patients were included in this study,495 in the on-pump group and 112 in the off-pump group.There were no statistical differences in the age,sex,basic diseases(hypertension,diabetes mellitus,and history of stroke),last preoperative EF and preoperative creatinine.The ventilator time was no statistical difference,but on-pump group had a longer ICU days than the off-pump group[(3.0±1.8)d vs(2.5±1.7)d,t=2.603,P=0.009].There was no significant difference in postoperative MACCE events and CRRT between the two groups.105 delirium in the on-pump group occurred(21.2%),whereas 14 in the off-pump group(12.5%).Inverse probability weighted regression analysis based on propensity score showed OR was 2.402(95%CI:1.337~4.317),P=0.004.Conclusion Off-pump coronary artery bypass grafting could reduce the incidence of delirium in the patients.

关 键 词：体外循环 非体外循环 冠状动脉旁路移植术 谵妄 

分 类 号：R654.2[医药卫生—外科学]