成人心脏术后亚谵妄综合征预测模型构建  

Construction of a predictive model of subsyndromal delirium after cardiac surgery in adults

作　　者：李飞[1] 李莉莉[1] 富燕萍[1] 张帅 钱正仙[2] 沃超男 呼邦传[1] 姚惠萍[1] Li Fei;Li Lili;Fu Yanping;Zhang Shuai;Qian Zhengxian;Wo Chaonan;Hu Bangchuan;Yao Huiping(Intensive Care Unit,Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical Collage,Hangzhou 310004,China;Cardiac Care Unit,Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical Collage,Hangzhou 310004,China)

机构地区：[1]浙江省人民医院/杭州医学院附属人民医院重症医学科,杭州310004 [2]浙江省人民医院/杭州医学院附属人民医院CCU,杭州310004

出　　处：《中华现代护理杂志》2021年第29期3948-3953,共6页Chinese Journal of Modern Nursing

基　　金：浙江省医药卫生科技计划项目(2020KY422)。

摘　　要：目的探讨引起成人心脏术后亚谵妄综合征(SSD)的危险因素并构建风险模型。方法采用便利抽样法,选取浙江省人民医院外科重症监护室(SICU)2017年1月1日—2018年12月31日收治的620例接受心脏手术的成人患者为研究对象,其中发生SSD的患者纳入SSD组,未发生SSD的患者纳入非SSD组。详细记录所有患者术前、术中及术后的临床资料及各项指标,通过单因素分析和二分类Logistic回归分析探讨引起成人心脏术后SSD的危险因素,并构建风险模型函数。结果最终纳入研究569例,其中未发生术后亚谵妄399例(非SSD组),发生术后亚谵妄170例(SSD组),SSD发生率为29.9%。单因素分析发现,引起成人心脏术后SSD的影响因素为年龄、急诊手术、APACHEⅡ评分、主动脉阻断时间、深低温停循环时间、术中输血浆量、SICU停留时间和使用右美托咪定,两组比较差异均有统计学意义(P<0.05)。二分类Logistic回归分析发现,年龄>76岁[优势比(OR)=4.332,95%置信区间(CI):(2.103~8.965),P<0.001]、急诊手术[OR=3.453,95%CI:(1.143~7.534),P<0.05]、APACHEⅡ评分>15分[OR=5.453,95%CI:(1.453~9.536),P<0.001]、深低温停循环时间>34.2 min[OR=2.132,95%CI:(1.053~5.532),P<0.05]和SICU停留时间>50.0 h[OR=1.675,95%CI:(0.832~5.233),P<0.05]是引起成人心脏术后SSD的独立危险因素,而使用右美托咪定[OR=1.536,95%CI:(0.763~4.862),P<0.05]是成人心脏术后SSD的保护因素。结论年龄>76岁、急诊手术、APACHEⅡ评分>15分、深低温停循环时间>34.2 min和SICU停留时间>50.0 h是引起成人心脏术后发生SSD的独立危险因素,而使用右美托咪定则可以减少SSD的发生。Objective To explore the risk factors of subsyndromal delirium(SSD)after cardiac surgery in adults and construct a risk model.Methods The convenience sampling method was used to select 620 adult patients undergoing cardiac surgery admitted to the Surgical Intensive Care Unit(SICU)of Zhejiang Provincial People's Hospital from January 1,2017 to December 31,2018 as the research object.Patients with postoperative SSD were included in the SSD group,and patients without postoperative SSD were included in the non-SSD group.The preoperative,intraoperative and postoperative clinical data and various indicators of all patients were recorded in detail.Through univariate analysis and binary Logistic regression analysis,the risk factors of SSD after cardiac surgery in adults were explored,and the risk model function was constructed.Results A total of 569 cases were included in the study.Among them,399 cases of postoperative subdelirium did not occur(non-SSD group),170 cases of postoperative subdelirium occurred(SSD group),and the incidence of SSD was 29.9%.Univariate analysis found that the influencing factors of adult SSD after cardiac surgery were age,emergency surgery,Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore,aortic occlusion time,deep hypothermia circulatory arrest time,intraoperative plasma transfusion,SICU stay time and the use of dexmedetomidine,and the differences between the two groups were statistically significant(P<0.05).The binary Logistic regression analysis found that age>76 years[odds ratio(OR)=4.332,95%confidence interval(CI):(2.103,8.965),P<0.001],emergency surgery[OR=3.453,95%CI:(1.143,7.534),P<0.05],APACHEⅡscore>15[OR=5.453,95%CI:(1.453,9.536),P<0.001],deep hypothermia circulatory arrest time>34.2 min[OR=2.132,95%CI:(1.053,5.532),P<0.05]and SICU stay time>50.0 h[OR=1.675,95%CI:(0.832,5.233),P<0.05]were independent risks of SSD after cardiac surgery in adults,and the use of dexmedetomidine[OR=1.536,95%CI:(0.763,4.862),P<0.05]was a protective factor.Conclusions Age>76 years,emergency s

关 键 词：心脏手术 亚谵妄综合征 危险因素 风险模型 

分 类 号：R654.2[医药卫生—外科学]