成人体外循环术后谵妄患者的回顾性分析  

Retrospective analysis of adult patients with delirium after cardiopulmonary bypass

作　　者：张志远[1] 许莉[2] 杜虹[1] 谷小卫[1] Zhang Zhiyuan;Xu Li;Du Hong;Gu Xiaowei

机构地区：[1]中国人民解放军联勤保障部队第988医院心胸外科,454000 [2]中国人民解放军联勤保障部队第988医院神经内科,454000

出　　处：《中国疗养医学》2022年第7期773-776,共4页Chinese Journal of Convalescent Medicine

摘　　要：目的分析成人体外循环术后患者谵妄的发生情况及其影响因素。方法回顾性分析2019年10月至2021年10月在联勤保障部队第988医院行体外循环手术成人患者98例,将其分为谵妄组和非谵妄组,并研究引起术后谵妄的相关因素。结果98例体外循环术后患者中有18例发生谵妄,谵妄发生率为18.4%;多个单因素方差分析及卡方检验分析结果表明:年龄、体外循环持续时间、人格评定、体外循环前后平均动脉压差值、ICU入住时间、急性生理学和慢性健康状况评分系统(APACHEⅡ)评分均具有不同程度的相关性,经过Logistic多因素回归分析结果显示,体外循环持续时间(回归系数0.065,P=0.004)、APACHEⅡ评分(回归系数2.272,P=0.022)、ICU入住时间(回归系数0.220,P=0.025)可能是成人体外循环术后发生谵妄的独立危险因素。ROC曲线分析显示最佳危险因素预测:体外循环持续时间ROC曲线下面积为0.955,最佳临界值144.5 min。结论体外循环术后患者谵妄发生率处于相对较高水平,体外循环持续时间、ICU入住时间、APACHEⅡ评分可能是体外循环术后谵妄的独立危险因素,体外循环的持续时间对术后谵妄的风险具有相对较好的预测价值,对这些危险因素进行相应的干预措施,可能对降低术后患者谵妄的发生率具有重要意义。Objective To an alyze the incidence and influencing factors of delirium in adult patients after cardiopulmonary bypass. Methods 98 adult patients who underwent cardiopulmonary bypass in No. 988 Hospital of the Joint Logistics Support Force from October 2019 to October 2021 were retrospectively analyzed. They were divided into delirium group and non delirium group,and the related factors causing postoperative delirium were studied.Results Delirium occurred in 18 of 98 patients after cardiopulmonary bypass,and the incidence of delirium was 18. 4 %;The results of multiple one-way ANOVA and chi-square test showed that age,duration of cardiopulmonary bypass,personality assessment,mean arterial pressure difference before and after cardiopulmonary bypass,ICU stay time,acute physiology chronic health evaluation scoring system(APACHE Ⅱ)scores had different degrees of correlation.The results of logistic multivariate regression analysis showed that the duration of cardiopulmonary bypass(regression coefficient 0.065,P=0.004)Apache Ⅱ score(regression coefficient 2.272,P=0.022) and ICU stay time(regression coefficient 0.220,P =0.025) may be independent risk factors for delirium after cardiopulmonary bypass in adults.ROC curve analysis showed that the best risk factor prediction :the duration of cardiopulmonary bypass,the area under the ROC curve was 0.955,and the best critical value was 144.5 min. Conclusion The incidence of delirium in patients after cardiopulmonary bypass is at a relatively high level.The duration of cardiopulmonary bypass,ICU stay time and APACHE Ⅱ score may be independent risk factors for delirium after cardiopulmonary bypass.The duration of cardiopulmonary bypass has a relatively good predictive value for the risk of postoperative delirium.The corresponding intervention measures for these risk factors may be of great significance to reduce the incidence of delirium in patients after cardiopulmonary bypass.

关 键 词：谵妄 体外循环 术后 成人 

分 类 号：R654.1[医药卫生—外科学]