急性A型主动脉夹层术后谵妄的影响因素  

Influencing factors of postoperative delirium in patients with acute type A aortic dissection

作　　者：晁珂 何发明[1] 李晓召[1] 曹向波[1] 车丽玲[1] 史博伦 李艳凤[1] 何慧 CAO Baojiang WANG Gang CHAO Ke;HE Faming;LI Xiaozhao;CAO Xiangbo;CHE Liling;SHI Bolun;CAO Baojiang;WANG Gang;LI Yanfeng(Extracardiac Care Unit,Henan Provincial Chest Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院心外监护室,450003

出　　处：《心肺血管病杂志》2022年第8期909-913,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190746);常州四药临床药学科研基金(CZSYJJ16026)。

摘　　要：目的:探讨右美托咪定是否可以降低急性A型主动脉夹层(AAAD)术后患者的谵妄发生率,以及AAAD术后发生谵妄的危险因素。方法:回顾性分析河南省胸科医院2014年至2017年间,AAAD术后患者,根据术后应用镇静药物分为两组,右美托咪定组(72例)与丙泊酚组(84例),比较两组患者谵妄发生率和住院时间、病死率的差异;单因素分析AAAD术后谵妄发生的风险因素;多因素Logistic回归在调整其他混杂因素后分析吸烟、BMI、CPB时间和DHCA时间是谵妄发生危险因素。结果:①右美托咪定组谵妄发生率显著低于丙泊酚组(33.3%vs.56.0%,P=0.005);②右美托咪定组患者住院时间低于丙泊酚组[(22.89±8.40)vs.(25.82±11.34)d,P<0.05];③单因素分析AAAD术后患者发生谵妄风险因素:BMI、吸烟、体外循环、深低温停循环时间、呼吸机时间与患者术后发生谵妄成正相关;④多因素回归分析Logistic:AAAD术后患者给予右美托咪定后谵妄发生风险(OR=0.444,95%CI:0.217~0.908,P=0.026),AAAD术后患者的BMI、吸烟、体外循环时间、深低温停循环时间与谵妄发生风险分别为(OR=1.123,P=0.004;OR=2.675,P=0.015;OR=1.013,P=0.023;OR=1.096,P=0.002)。结论:右美托咪定用于AAAD术后治疗的危重患者可缩短住院时间,降低谵妄发生率,同时我们发现吸烟、BMI、深低温停循环时间和体外循环时间是AAAD术后患者谵妄发生的危险因素。Objective:Whether dexmedetomidine can reduce the incidence of delirium in patients after acute type A aortic dissection(AAAD),and to explore the risk factors for delirium after AAAD.Methods:Using retrospective research methods,we selected the patients after AAAD in Henan Chest Hospital from 2014 to 2017,and divided them into two groups based on the postoperative sedative drugs,dexmedetomidine group(72 cases)and propofol group(84 cases).Example),analyze and compare the differences in the incidence of delirium,length of stay,and mortality between the two groups of patients;single factor analysis of risk factors for delirium after AAAD;multivariate logistic regression analysis of smoking,BMI,CPB time after adjusting for other confounding factors Time and DHCA are independent risk factors for the development of delirium.Results:①The incidence of delirium in the dexmedetomidine group was significantly lower than that in the propofol group(33.3%vs.56.0%,P=0.005);②The hospital stay in the dexmedetomidine group was lower than that in the propofol group[(22.89±8.40)vs.(25.82±11.34)d,P<0.05];③Single factor analysis of risk factors for delirium in patients after AAAD:body mass index(BMI),smoking,cardiopulmonary bypass,deep hypothermia circulatory arrest time,ventilator time and the patient's postoperative delirium are positive Correlation;④Multivariate regression Logistic analysis:the risk of delirium in patients after AAAD after dexmedetomidine(OR=0.444,95%CI:0.217-0.908,P=0.026),BMI,Smoking,cardiopulmonary bypass time,deep hypothermia circulatory arrest time and the risk of delirium were(OR=1.123,P=0.004;OR=2.675,P=0.015;OR=1.013,P=0.023;OR=1.096,P=0.002).Conclusions:The use of dexmedetomidine in critically ill patients treated after AAAD can shorten the length of hospital stay and reduce the incidence of delirium.At the same time,we found that smoking,BMI,deep hypothermic circulatory arrest time and extracorporeal circulation time are independent risks of delirium in patients after AAAD factor.

关 键 词：急性A型主动脉夹层 右美托咪定 谵妄 

分 类 号：R54[医药卫生—心血管疾病]