丙泊酚镇静体外循环下心脏瓣膜置换术后谵妄发生的影响因素分析  

Influencing factors of delirium after cardiac valve replacement under cardiopulmonary bypass with propofol sedation

作　　者：杜守峰[1] 师文华[1] 孙君隽[1] 韩冬[1] DU Shoufeng;SHI Wenhua;SUN Junjun;HAN Dong(Department of Cardiovascular Surgery,Nanyang Central Hospital,Nanyang 473009,Henan Province,China)

机构地区：[1]南阳市中心医院心脏大血管外科,河南南阳473009

出　　处：《新乡医学院学报》2024年第1期65-70,共6页Journal of Xinxiang Medical University

摘　　要：目的探讨丙泊酚镇静体外循环(CPB)下心脏瓣膜置换术后谵妄发生的影响因素。方法选择2020年1月至2022年12月于南阳市中心医院行CPB下心脏瓣膜置换术患者152例为研究对象,依据丙泊酚镇静深度将患者分为观察A组[50≤脑电双频指数(BIS)<60]和观察B组(35≤BIS<45),每组76例。收集患者的年龄、性别、体质量指数(BMI)、糖尿病、高血压、冠状动脉性心脏病、慢性阻塞性肺疾病、睡眠障碍、营养障碍、焦虑、抑郁、吸烟史、饮酒史、术前心功能不全、术中低氧血症、术中低蛋白血症、术后急性肾损伤、二次插管、大量输血、过度疼痛、术后左心室射血分数(LVEF)、手术方式、CPB时间等临床资料,采用重症监护病房(ICU)患者意识模糊评估法(CAM-ICU)评估患者术后谵妄发生情况。比较观察A组和观察B组患者术后谵妄发生情况;应用单因素和多因素logistic回归分析术后谵妄发生的影响因素。结果152例心脏瓣膜置换术患者有36例发生术后谵妄,发生率为23.68%。观察A组和观察B组患者术后谵妄发生率分别为38.16%(29/76)、9.21%(7/76),观察A组患者术后谵妄发生率显著高于观察B组(χ^(2)=17.617,P<0.05)。性别、BMI、合并糖尿病、合并高血压、合并冠状动脉性心脏病、合并认知障碍、合并睡眠障碍、合并营养障碍、合并焦虑、合并抑郁、吸烟史、饮酒史、术中低氧血症、术中低蛋白血症、术后急性肾损伤、二次插管、大量输血、手术方式与患者术后谵妄发生无关(P>0.05);年龄、慢性阻塞性肺疾病、术前心功能不全、过度疼痛、术后LVEF、CPB时间与患者术后谵妄发生相关(P<0.05)。多因素logistic回归分析显示,年龄≥60岁、术前心功能不全、过度疼痛、CPB时间≥100 min是患者术后谵妄发生的危险因素(P<0.05),术后LVEF≥50%、丙泊酚镇静深度35≤BIS<45是患者术后谵妄发生的保护因素(P<0.05)。结论丙泊酚Objective To investigate the influencing factors of delirium after cardiac valve replacement went under cardiopulmonary bypass(CPB)with propofol sedation.Methods A total of 152 patients underwen t cardiac valve replacement under CPB in Nanyang Central Hospital from January 2020 to December 2022 were selected as research objects,and they were randomly divided into observation group A[50≤bispectral index(BIS)<60]and observation group B(35≤BIS<45)according to the depth of propofol sedation,with 76 cases in each group.The clinical data such as age,gender,body mass index(BMI),diabetes,hypertension,coronary heart disease,chronic obstructive pulmonary disease,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,preoperative cardiac insufficiency,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,excessive pain,postoperative left ventricular ejection fraction(LVEF),surgical method and CPB time were collected,and the incidence of postoperative delirium of patients was evaluated by the confusion assessment method of intensive care unit(CAM-ICU)method.The incidence of postoperative delirium of patients between observation group A and observation group B was compared.The influencing factors of postoperative delirium occurrence was analyzed by using univariate and multivariate logistic regression analysis.Results Among the 152 patients underwent heart valve replacement,36 patients experienced postoperative delirium,with an incidence of 23.68%.The incidence of postoperative delirium of patients in the observation g roup A and the observation group B was 38.16%(29/76),9.21%(7/76),respectively;the incidence of postoperative delirium of patients in the observation group A was significantly higher than that in the observation group B(χ^(2)=17.617,P<0.05).The gender,BMI,diabetes,hypertension,coronary heart disease,cognitive disorder,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinki

关 键 词：丙泊酚 镇静深度 体外循环 心脏瓣膜置换术 术后谵妄 

分 类 号：R654.2[医药卫生—外科学]