Debakey Ⅲ型主动脉夹层腔内隔绝术后谵妄及危险因素相关性分析  

Correlation analysis of clinical characteristics and risk factors of delirium after endovascular isolation of Debakey typeⅢaortic dissection

作　　者：黄新新 丁琦 张欢欢 马倩倩 王淑红[1] HUANG Xinxin;DING Qi;ZHANG Huanhuan;MA Qianqian;WANG Shuhong(Department of Cardiovascular Intensive Care Unit,Zhengzhou Seventh People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院心血管重症监护病房,450000

出　　处：《心肺血管病杂志》2023年第8期834-838,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨DebakeyⅢ型主动脉夹层腔内隔绝术后患者谵妄发生情况及影响因素,为制定针对性预防措施提供参考。方法:收集2019年1月至2021年12月,行血管腔内隔绝术治疗DebakeyⅢ型主动脉夹层166例患者临床资料,分为谵妄组(24例)和非谵妄组(142例)。比较两组一般资料和手术相关资料,采用多因素Logistic回归分析谵妄发生的影响因素。结果:(1) 166例DebakeyⅢ型主动脉夹层患者中,围术期出现谵妄24例,发生率为14.5%(24/176)。其中一过性谵妄(79.2%)、持续性谵妄(20.8%)、精神运动性兴奋(83.3%)、睡眠-觉醒周期紊乱(79.2%)、意识水平改变(66.7%)、记忆力减退(58.3%)、定向力障碍(45.8%)、思维紊乱或不连贯(29.2%)等。(2)谵妄组患者年龄、ⅢB型、脑血管疾病、低氧血症、手术时间、麻醉时间、机械通气时间、住院时间均高于(或长于)非谵妄组(P<0.05)。(3)年龄(OR=4.311, 95%CI:2.132~9.423)、ⅢB型(OR=2.332, 95%CI:1.309~5.152)、低氧血症(OR=2.509, 95%CI:1.452~6.143)、麻醉时间(OR=3.144,95%CI:1.355~6.373)、机械通气时间(OR=2.431, 95%CI:1.262~5.344)是谵妄发生的危险因素。结论:DebakeyⅢ型主动脉夹层术后谵妄发生与高龄、ⅢB型、脑血管疾病、低氧血症、麻醉时间及机械通气时间明显相关,应采取针对性干预措施,以减少DebakeyⅢ型主动脉夹层围术期谵妄发生率。Objective:To investigate the occurrence and influencing factors of delirium in patients with DebakeyⅢtype aortic dissection after endovascular isolation,and to provide reference for formulating targeted preventive measures.Methods:Collect clinical data of 166 patients with Debakey III aortic dissection who underwent endovascular isolation surgery from January 2019 to December 2021,divided into a delirium group(24 cases)and a non delirium group(142 cases).Compare two sets of general data and surgical related data,and use multivariate logistic regression analysis to analyze the influencing factors of delirium occurrence..Results:①Among 166 Debakey III aortic dissection patients,24 had delirium during the perioperative period,with an incidence rate of 14.5%(24/176).Among them,transient delirium(79.2%),persistent delirium(20.8%),psychomotor excitement(83.3%),sleep wakefulness cycle disorder(79.2%),altered consciousness level(66.7%),memory loss(58.3%),disorientation(45.8%),thinking disorder or discontinuity(29.2%),etc Age,type IIIB,cerebrovascular disease,hypoxemia,operation time,anesthesia time,mechanical ventilation time,and hospital stay in the delirium group were higher(or longer)than those in the non delirium group(P<0.05)Age(OR=4.311,95%CI:2.132-9.423),typeⅢB(OR=2.332,95%CI:1.309~5.152),hypoxemia(OR=2.509,95%CI:1.452-6.143),duration of anesthesia(OR=3.144,95%CI:1.355-6.373),duration of mechanical ventilation(OR=2.431,95%CI:1.262-5.344)are independent risk factors for delirium.Conclusions:The occurrence of perioperative delirium in Debakey typeⅢaortic dissection is significantly related to old age,ⅲB type,hypoxemia,anesthesia time and mechanical ventilation time.Targeted intervention measures should be taken to reduce the incidence of perioperative delirium in Debakey typeⅢaortic dissection.

关 键 词：主动脉夹层 腔内隔绝术 谵妄 临床特征 危险因素 

分 类 号：R54[医药卫生—心血管疾病]