主动脉夹层A型术后复温时间与谵妄发生的相关性分析  

Analysis of correlation between rewarming time and delirium after aortic dissection type A

作　　者：刘华雪 王瑞[2] 李方[2] 陈祖君[3] LIU Hua-Xue;WANG Rui;LI Fang;CHEN Zu-Jun(Shandong Cardiovascular Surgery Ward of the First Medical University Affiliated Provincial Hospital,Jining 250021,China;Adult Surgery Ward 7,Chinese Academy of medical sciences and Peking Union Medical College,Fuwai Hospital,National Center for Cardiovescular Diseases,Beijing 100037,China;SICU,Chinese Academy of medical sciences and Peking Union Medical College,Fuwai Hospital,National Center for Cardiovescular Diseases,Beijing 100037,China)

机构地区：[1]山东第一医科大学附属省立医院心外科,山东省济南市250021 [2]中国医学科学院北京协和医学院国家心血管中心阜外医院成人外科七病区 [3]中国医学科学院北京协和医学院国家心血管中心阜外医院SICU

出　　处：《中国心血管病研究》2023年第12期1116-1121,共6页Chinese Journal of Cardiovascular Research

基　　金：中国医学科学院北京协和医学院国家心血管中心阜外医院立项课题(CRFH20180077)。

摘　　要：目的主动脉夹层A型术后复温时间与谵妄发生的相关性分析。方法回顾性分析中国医学科学院北京协和医学院国家心血管中心阜外医院外科SICU 2020年1月至2022年12月期间主动脉夹层A型术后患者295例患者资料,包括基本情况、基础疾病、手术时间、术后最高钠离子值,肌酐值,总胆红素值,直接胆红素值、深低温停循环时间、脑保护方式以及术后谵妄发生情况。结果共295例患者纳入研究,其中119例发生术后谵妄,发生率40.3%。即刻体温36℃以上的患者共47例,发生谵妄的例数为22例。1~5 h复温到36℃的总例数为161例,发生谵妄的例数为10例,发生率为6.2%。6~10 h复温到36℃的总例数为76例,全部病例发生谵妄,发生率为100%。复温时间>10 h的病例例数为11例,全部发生谵妄,发生率100%。差异有统计学意义,四组之间的χ^(2)为207.1(P≤0.01)。多因素logistic回归分析结果显示在控制了脑卒中病史、急诊手术、最高钠离子值、肌酐值、手术时间、深低温停循环时间、脑保护方式因素的影响后,复温时间过长(OR=3.01,95%CI 1.22~7.38,P<0.02),术后发生谵妄的危险越高。结论主动脉夹层A型术后复温时间越长,谵妄发生风险越高。Objective To analyze the correlation between rewarming time and delirium after aortic dissection type A.Methods The data of 295 patients undergoing type A surgery after aortic dissection were retrospectively analyzed in the Department of Surgery SICU,National Cardiovascular Center,Peking Union Medical College,Chinese Academy of Medical Sciences,Fuwai Hospital,from January 2020 to December 2022,including basic information,underlying diseases,operation time,postoperative maximum sodium ion value,creatinine value,total bilirubin value,and the following:Direct bilirubin value,hypothermia stop time,brain protection mode and postoperative delirium occurrence.Results A total of 295 patients were included in the study,119 of whom developed postoperative delirium(40.3%).A total of 47 patients had an immediate temperature above 36℃,and 22 had delirium.The total number of people who rewarmed at 36℃for 1-5 h was 161,and the number of delirium occurred in 10 people,with an incidence of 6.2%.The total number of patients with 6-10 h rewarming at 36℃was 76,and delirium occurred in all the cases,with an incidence of 100%.Eleven patients with rewarming time>10 h experienced delirium,with an incidence of 100%.The difference was statistically significant(χ2=207.1,P≤0.01).Multivariate logistic regression analysis showed that after controlling for stroke history,emergency surgery,maximum sodium ion value,creatinine value,operation time deep hypothermia circulatory arrest time,cerebral protection,the longer rewarming time(OR=3.01,95%CI 1.22-7.38,P<0.02),the higher the risk of postoperative delirium.Conclusion The longer rewarming time after aortic dissection type A,the higher the risk of delirium.

关 键 词：主动脉夹层A型 复温时间 谵妄 

分 类 号：R654.2[医药卫生—外科学]