心脏外科不同疾病患者合并睡眠障碍的状况及其相关因素  

Characteristics and correlated factors of preoperative sleep disorders in cardiac surgical patients

作　　者：何萌[1] 来永强[1] 张喜维 许斌[3] 马珠江 张青格 宋王婷 杨秀滨 华琨[1] 崔颢 雷笑 王云霞 马晨超 张子恒 王晓怡 蔡龙军 沈珊 许华 He Meng;Lai Yongqiang;Zhang Xiwei;Xu Bin;Ma Zhujiang;Zhang Qingge;Song Wangting;Yang Xiubin;Hua Kun;Cui Hao;Lei Xiao;Wang Yunxia;Ma Chenchao;Zhang Ziheng;Wang Xiaoyi;Cai Longjun;Shen Shan;Xu Hua(Department of Structural Cardiology Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Nursing Department of Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Operating Room of Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Institut of Brain Science and Achievement Transformation,Beijing 100089,China)

机构地区：[1]首都医科大学附属北京安贞医院结构性心脏病外科中心,北京100029 [2]首都医科大学附属北京安贞医院护理部,北京100029 [3]首都医科大学附属北京安贞医院手术室,北京100029 [4]脑动极光脑科学研究与成果转化研究院,北京100089

出　　处：《中华医学杂志》2024年第40期3745-3750,共6页National Medical Journal of China

基　　金：国家自然科学基金(82170374)。

摘　　要：目的分析心脏外科不同疾病患者合并睡眠障碍的状况及其相关因素。方法回顾性纳入2023年4月至2024年2月于首都医科大学附属北京安贞医院结构性心脏病外科中心就诊的患者,收集所有患者人口学信息、认知精神症状评估量表评分等相关资料,按照心脏外科手术诊断分为冠心病、瓣膜病、大血管病、先天性心脏病和其他5类,依据匹兹堡睡眠质量指数(PSQI)量表评估情况分为睡眠障碍组和对照组(睡眠正常),进一步比较不同疾病两组患者的人口学特征及认知功能和情绪状态,采用多因素logistic回归模型分析不同疾病患者发生睡眠障碍的相关因素。结果共纳入1016例患者,其中男701例,女315例,年龄(58.6±12.7)岁,睡眠障碍总检出率为45.6%(463/1016)。多因素logistic回归分析结果显示,年龄增大是冠心病(OR=1.050,95%CI:1.026~1.077)、瓣膜病(OR=1.033,95%CI:1.013~1.053)患者发生睡眠障碍的相关因素;抑郁自评量表(SDS)得分高是瓣膜病患者发生睡眠障碍的相关因素(OR=1.050,95%CI:1.013~1.091);而蒙特利尔认知评估(MoCA)量表分项‑抽象能力评分高是冠心病患者发生睡眠障碍的保护因素(OR=0.695,95%CI:0.490~0.981)。结论心脏外科疾病合并睡眠障碍的发生率较高,年龄增大、抑郁状态、抽象能力是心脏外科疾病患者发生睡眠障碍的相关因素,并因疾病类型而异。Objective To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery.Methods The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital,Capital Medical University,from April 2023 to February 2024 were retrospectively collected.Patients were categorized into five groups based on cardiac surgical diagnosis:coronary heart disease,valvular disease,large vessel disease,congenital heart disease,and others.Each group was further subdivided into normal sleep(NS)and sleep disorder(SD)groups based on the Pittsburgh Sleep Quality Index(PSQI)scores.Demographic information,cognitive function,psychiatric symptoms,and other relevant data were collected.Clinical characteristics were compared between groups,and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression.Results A total of 1016 patients aged(58.6±12.7)years were included in the study,including 701 males and 315 females.The incidence of SD was 45.6%(463/1016).Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease(OR=1.050,95%CI:1.026-1.077)and valvular disease(OR=1.033,95%CI:1.013-1.053).High Self‑rating Depression Scale(SDS)score was a risk factor for sleep disorders in patients with valvular disease(OR=1.050,95%CI:1.013-1.091).High score on the Montreal Cognitive Assessment(MoCA)subitem‑abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease(OR=0.695,95%CI:0.490-0.981).Conclusions The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease.Aging,depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.

关 键 词：睡眠障碍 心脏外科 相关因素 

分 类 号：R47[医药卫生—护理学]