Stanford A型主动脉夹层患者术后发生谵妄的影响因素  

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

作　　者：黄剑锋[1] 龚强 熊建英[1] 黎杨 袁明明 吴起才[1] HUANG Jianfeng;GONG Qiang;XIONG Jianying;LI Yang;YUAN Mingming;WU Qicai(Department of Cardiac and Vascular Surgery of the First Affiliated Hospital of Nanchang University,Nanchang 330006 Jiangxi,China)

机构地区：[1]南昌大学第一附属医院心脏大血管外科,江西南昌330006

出　　处：《中国民康医学》2024年第13期5-8,12,共5页Medical Journal of Chinese People’s Health

基　　金：江西省教育厅科学技术研究项目(GJJ210142)。

摘　　要：目的:分析Stanford A型主动脉夹层(ATAD)患者术后发生谵妄的影响因素。方法:回顾性分析2020年1月至2023年12月该院收治的176例ATAD患者的临床资料,患者均接受孙氏手术治疗,统计术后1周内谵妄发生率,采用单因素和多因素Logistic回归分析术后谵妄发生的影响因素。结果:176例ATAD患者中,术后1周内发生谵妄39例(22.16%),记为发生组,未发生谵妄137例(77.84%),记为未发生组;发生组有饮酒史、术中低血压、术中高血糖、术后血细胞比容(Hct)<30%、术后静脉镇痛及术后发生感染、心肌梗死、脑梗死者占比均高于未发生组,术后氧合指数低于未发生组,深低温停循环时间、体外循环时间均长于未发生组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,有饮酒史、术中低血压、术中高血糖、深低温停循环时间过长、体外循环时间过长、术后氧合指数低、术后Hct<30%、术后静脉镇痛及术后发生感染、低体温、心肌梗死、脑梗死均是ATAD患者术后发生谵妄的独立危险因素(OR>1,P<0.05)。结论:ATAD患者术后谵妄发生率较高。有饮酒史、术中低血压、术中高血糖、深低温停循环时间过长、体外循环时间过长、术后氧合指数低、术后Hct<30%、术后静脉镇痛及术后发生感染、低体温、心肌梗死、脑梗死均是ATAD患者术后发生谵妄的独立危险因素。Objective:To analyze influencing factors of postoperative delirium in patients with Stanford type A aortic dissection(ATAD).Methods:The clinical data of 176 patients with ATAD admitted to the hospital from January 2020 to December 2023 were retrospectively analyzed.All patients received Sun's surgery.The incidence of delirium within 1 week after the surgery was statistically analyzed.Univariate and multivariate Logistic regression analysis were performed on the related factors of postoperative delirium.Results:Among the 176 patients with ATAD,39 patients(22.16%) had postoperative delirium within 1 week after the surgery,which was recorded as the occurrence group,and 137 patients(77.84%) did not have postoperative delirium,which was recorded as the non-occurrence group.The proportions of the patients with drinking history,intraoperative hypotension,intraoperative hyperglycemia,postoperative hematocrit(Hct) <30%,postoperative intravenous analgesia,postoperative infection,myocardial infarction and cerebral infarction in the occurrence group were higher than those in the non-occurrence group,the postoperative oxygenation index was lower than that in the non-occurrence group,the deep hypothermic circulatory arrest time and cardiopulmonary bypass time were longer than those in the non-occurrence group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that drinking history,intraoperative hypotension,intraoperative hyperglycemia,long deep hypothermic circulatory arrest time,long extracorporeal circulation time,low postoperative oxygenation index,postoperative Hct < 30%,postoperative intravenous analgesia,postoperative infection,hypothermia,myocardial infarction and cerebral infarction were independent risk factors for postoperative delirium(OR>1,P<0.05).Conclusions:The incidence of postoperative delirium in the patients with ATAD is high.Drinking history,intraoperative hypotension,intraoperative hyperglycemia,long time of deep hypothermic circulatory arrest,long extracorporeal

关 键 词：Stanford A型 主动脉夹层 孙氏手术 术后谵妄 影响因素 

分 类 号：R654.3[医药卫生—外科学]