睡眠障碍对心脏外科手术患者ICU住院时间的影响:基于MIMIC-Ⅳ数据库的回顾性队列研究  

Effect of sleep disorder on intensive care unit stay in patients undergoing cardiac surgery:a retrospective cohort study based on the Medical Information Mart for Intensive Care IV database

作　　者：黄捷 朱雅琳 欧阳雨漫 王嘉锋 Huang Jie;Zhu Yalin;Ouyang Yuman;Wang Jiafeng(Faculty of Anesthesiology,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Anesthesiology,Naval Hospital of Eastern Theater,Zhoushan 316100,China;School of Anesthesiology,Shangdong Second Medical University,Weifang 261053,China)

机构地区：[1]海军军医大学第一附属医院麻醉学部,上海200433 [2]东部战区海军医院麻醉科,舟山316100 [3]山东第二医科大学麻醉学院,潍坊261053

出　　处：《国际麻醉学与复苏杂志》2024年第11期1175-1180,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82072147)。

摘　　要：目的探讨心脏外科手术患者睡眠障碍与重症监护治疗病房(ICU)住院时间延长的相关性。方法选取2008年至2019年在重症监护医学数据集(MIMIC-Ⅳ)数据库中接受过心脏外科手术且术后入住ICU的患者。根据是否有睡眠障碍, 将患者分为睡眠正常组和睡眠障碍组。收集患者在ICU的基线指标、合并症、生命体征和实验室检查指标等。采用单因素和多因素logistic回归分析确定ICU住院时间延长的独立危险因素, 并对睡眠障碍与ICU住院时间延长及谵妄进行相关性分析。结果共纳入心脏外科手术患者6 319例。与睡眠正常组比较, 睡眠障碍组患者慢性肺部疾病和肝脏疾病比例更高(均P<0.05), 其余基线指标差异无统计学意义(均P>0.05)。睡眠障碍组患者ICU住院时间延长发生率高于睡眠正常组(P<0.05), 两组患者谵妄发生率差异无统计学意义(P>0.05)。多因素logistic回归分析表明, 女性、充血性心力衰竭、肾脏疾病、周围血管疾病、平均血压、呼吸频率、平均红细胞体积、红细胞体积分布宽度、血尿素氮、部分凝血活酶时间、乳酸、谵妄、睡眠障碍是心脏外科手术患者ICU住院时间延长的独立危险因素。睡眠障碍与ICU住院时间延长存在显著相关性[风险比(HR)1.42, 95%置信区间(CI)1.03~1.96, P<0.05], 在调整年龄、性别、人种、合并症后, 这种关联仍有统计学意义(HR 1.48, 95%CI 1.06~2.08, P<0.05);但睡眠障碍没有增加该类患者发生谵妄的风险(P>0.05)。结论睡眠障碍预示心脏外科手术患者的ICU住院时间延长的风险较高。Objective To explore the association between sleep disorders and prolonged intensive care unit(ICU)stay in pa-tients undergoing cardiac surgery.Methods Patients who underwent cardiac surgery before admission to the ICU from 2008 to 2019 in the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ)database were selected.Based on the presence of sleep disorders,the patients were divided into two groups:a normal sleep group and a sleep disorder group.Their ICU data,including baseline vari-ables,comorbidities,vital signs,and laboratory test results,were collected.Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for prolonged ICU stay,and the correlation between sleep disorders and prolonged ICU stay and delirium was analyzed.Results A total of 6319 post-cardiac surgery patients were included.Compared with the normal sleep group,patients in the sleep disorder group showed an increased proportion of chronic lung disease and liver disease(all P<0.05),while the differences in other baseline indicators were not statistically significant(all P>0.05).The incidence of prolonged ICU stay was significantly higher in the sleep disorder group than in the normal sleep group(P<0.05),while the incidence of delirium was not signifi-cantly different between the two groups(P>0.05).Multivariate logistic regression analysis indicated that female gender,congestive heart failure,kidney disease,peripheral vascular disease,mean blood pressure,respiratory rate,mean corpuscular volume,red cell distribution width,blood urea nitrogen,activated partial thromboplastin time,lactate,delirium,and sleep disorders were independent factors for prolonged ICU stay in cardiac surgery patients.Sleep disorder was significantly associated with prolonged ICU stay[hazard ratio(HR)1.42(95%confidence interval(CI)1.03,1.96),P=0.034],and this association remained statistically significant after adjusting for age,gender,race,and comorbidities[HR 1.48(95%CI 1.06,2.08),P<0.05].However,sleep disorders did

关 键 词：睡眠障碍 心脏外科手术 重症监护治疗病房 住院时间 谵妄 

分 类 号：R614[医药卫生—麻醉学]