老年心脏瓣膜置换术患者术后谵妄现状及影响因素分析  

Status and influencing factors of postoperative delirium in elderly patients undergoing heart valve replacement

作　　者：刘雅楠 赵伟娣[2] 马惠欣[2] 姜巍[2] Liu Yanan;Zhao Weidi;Ma Huixin;Jiang Wei(Intensive Care Unit,Guangdong Provincial People's Hospital Zhuhai Hospital(Zhuhai Golden Bay Central Hospital),Zhuhai 519000,China;Intensive Care Ward Area B,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]广东省人民医院珠海医院(珠海市金湾中心医院)ICU,珠海519000 [2]哈尔滨医科大学附属第二医院重症加强治疗病房B区,哈尔滨150086

出　　处：《中华现代护理杂志》2022年第29期4006-4010,共5页Chinese Journal of Modern Nursing

基　　金：黑龙江省教育厅科学技术研究(面上)项目计划(12541495)。

摘　　要：目的:探讨老年心脏瓣膜置换术患者术后谵妄发生现状,并分析其术前衰弱与术后谵妄的关系。方法:采用便利抽样法,选取2018年8月—2021年8月在广东省人民医院珠海医院(珠海市金湾中心医院)心血管科接受心脏瓣膜置换术的156例老年患者为研究对象,术前采用一般资料调查表及衰弱量表对患者进行调查,术后第3天采用意识错乱评估法对患者进行评估。采用二项Logistic回归分析探讨老年心脏瓣膜置换术患者术后谵妄的危险因素。共发放156份问卷,剔除无效问卷11份,最终收集有效问卷145份,有效回收率为92.95%(145/156)。结果:145例老年心脏瓣膜置换术患者,术后发生谵妄42例(28.97%),术后未发生谵妄103例(71.03%);术前处于衰弱状态76例(52.41%),术前处于非衰弱状态69例(47.59%),其中术前衰弱患者中术后发生谵妄31例(40.79%,31/76),术前非衰弱患者中术后发生谵妄11例(15.94%,11/69)。二项Logistic回归分析结果显示,年龄、术前衰弱及术前心功能不全是老年心脏瓣膜置换术患者术后发生谵妄的影响因素( P<0.05)。 结论:老年心脏瓣膜置换术患者术后谵妄的发生率较高,年龄>75岁、术前处于衰弱状态、合并心功能不全的患者易发生术后谵妄。Objective To explore the current status of postoperative delirium in elderly patients with heart valve replacement and to analyze the relationship between preoperative weakness and postoperative delirium.Methods The convenient sampling method was used to select 156 elderly patients who received heart valve replacement surgery in Department of Cardiovascular Surgery of Guangdong Provincial People's Hospital Zhuhai Hospital(Zhuhai Golden Bay Central Hospital)from August 2018 to August 2021 as the research objects.The general information questionnaire and Frailty Scale were used to investigate the patients before operation,and Confusion Assessment Methods was used to evaluate the patients on the 3rd day after operation.Binomial logistic regression analysis was used to investigate the risk factors of postoperative delirium in elderly patients with heart valve replacement.A total of 156 questionnaires were distributed,11 invalid questionnaires were excluded and 145 valid questionnaires were finally collected,with an effective recovery rate of 92.95%(145/156).Results Among 145 elderly patients with heart valve replacement,42 cases(28.97%)developed delirium after operation and 103 cases(71.03%)did not develop delirium after operation.76 cases(52.41%)were frailty before operation,69 cases(47.59%)were non-frailty before operation.Among which 31 cases(40.79%,31/76)of preoperative frailty patients developed postoperative delirium and 11 cases(15.94%,11/69)of preoperative non-frailty patients developed postoperative delirium.Binomial Logistic regression analysis showed that age,preoperative frailty and preoperative cardiac dysfunction were the influencing factors of postoperative delirium in elderly patients undergoing heart valve replacement(P<0.05).Conclusions The incidence of postoperative delirium is high in elderly patients with heart valve replacement.Patients older than 75 years,in a frailty state before surgery and in combination with cardiac insufficiency are prone to postoperative delirium.

关 键 词：老年人 心脏瓣膜置换术 术后谵妄 危险因素 

分 类 号：R473.6[医药卫生—护理学]