CAJ | 학술논문

目的研究主动脉夹层术后谵妄的发生率、临床特点以及相关危险因素.方法以2013年1-12月北京安贞医院主动脉夹层术后患者为研究对象,以意识错乱评估方法作为谵妄诊断工具,分析术后谵妄的发生率和危险因素.结果共有84例患者纳入研究,发生术后谵妄28例,发生率为33.3％.21例(75.0％)为一过性谵妄(＜24 h);7例(25.0％)为持续性谵妄.术后谵妄最常见的表现是精神运动性兴奋(23例,82.1％);其次是睡眠-觉醒周期紊乱(21例,75.0％);多数患者有思维紊乱或者不连贯、定向力障碍、意识水平改变.将术后谵妄的危险因素分为术前、术中和术后危险因素,并对其进行单因素分析和多因素回归分析.与谵妄发生有关的术前危险因素包括左心室射血分数≤30％[P=0.023,比值比(OR)=1.99,95％置信区间(CI):1.29～3.31]、脑梗死(P=0.002,OR=2.86,95％ CI:1.43 ～ 5.72);术中危险因素包括手术持续时间(P=0.023,OR =0.90,95％ CI:0.49 ～ 1.67)、深低温停循环时间(P =0.019,OR=1.18,95％ CI:1.06 ～2.97);术后危险因素包括机械通气时间(P =0.043,OR=1.17,95％ CI:1.00 ～1.37)、血氧饱和度(P=0.001,OR=2.77,95％ CI:1.51 ～5.11)、重症监护病房时间(P=0.036,OR=1.10,95％ CI:1.10～1.21),上述各因素对术后谵妄的影响差异有统计学意义(P＜0.05).Logistic多因素回归分析结果表明脑梗死(P=0.017,OR=1.48,95％ CI:1.07 ～2.04)、深低温停循环时间(P=0.002,OR=2.86,95％ CI:1.43 ～5.72)、重症监护病房时间(P=0.030,OR =2.18,95％ CI:1.07 ～4.44)是术后谵妄的独立危险因素.结论既往脑梗死、深低温停循环时间、重症监护病房持续时间是术后谵妄的独立危险因素.
목적 연구주동맥협층술후섬망적발생솔、림상특점이급상관위험인소.방법 이2013년1-12월북경안정의원주동맥협층술후환자위연구대상,이의식착란평고방법작위섬망진단공구,분석술후섬망적발생솔화위험인소.결과 공유84례환자납입연구,발생술후섬망28례,발생솔위33.3％.21례(75.0％)위일과성섬망(＜24 h);7례(25.0％)위지속성섬망.술후섬망최상견적표현시정신운동성흥강(23례,82.1％);기차시수면-각성주기문란(21례,75.0％);다수환자유사유문란혹자불련관、정향력장애、의식수평개변.장술후섬망적위험인소분위술전、술중화술후위험인소,병대기진행단인소분석화다인소회귀분석.여섬망발생유관적술전위험인소포괄좌심실사혈분수≤30％[P=0.023,비치비(OR)=1.99,95％치신구간(CI):1.29～3.31]、뇌경사(P=0.002,OR=2.86,95％ CI:1.43 ～ 5.72);술중위험인소포괄수술지속시간(P=0.023,OR =0.90,95％ CI:0.49 ～ 1.67)、심저온정순배시간(P =0.019,OR=1.18,95％ CI:1.06 ～2.97);술후위험인소포괄궤계통기시간(P =0.043,OR=1.17,95％ CI:1.00 ～1.37)、혈양포화도(P=0.001,OR=2.77,95％ CI:1.51 ～5.11)、중증감호병방시간(P=0.036,OR=1.10,95％ CI:1.10～1.21),상술각인소대술후섬망적영향차이유통계학의의(P＜0.05).Logistic다인소회귀분석결과표명뇌경사(P=0.017,OR=1.48,95％ CI:1.07 ～2.04)、심저온정순배시간(P=0.002,OR=2.86,95％ CI:1.43 ～5.72)、중증감호병방시간(P=0.030,OR =2.18,95％ CI:1.07 ～4.44)시술후섬망적독립위험인소.결론 기왕뇌경사、심저온정순배시간、중증감호병방지속시간시술후섬망적독립위험인소.
Objective To study the morbidity,clinical presentation and risk factors of postoperative delirium after aortic dissection surgery.Methods All 84 patients after aortic dissection surgery were evaluated with Confusion Assessment Method (CAM).Results Delirium occurred in 28 patients and morbidity of postoperative delirium was 33.3％.Twenty-one patients (75.0％) suffered from transient delirium (＜ 24 h).Seven patients (25.0％) suffered from continuous delirium.The common clinical symptoms of delirium included increasing psychomotor activity (82.1％),a disordered sleep-wake cycle (75.0％),a reduced level of consciousness,attention abnormalities and cognitive impairments.Variables were analyzed by uni-/multivariable logistic regression,including preoperative variables,intraoperative variables and postoperative variables.Univariate logistic regression analysis results showed that delirium was associated with left ventricular ejection fraction (≤30％) [P =0.023,odds ratio (OR) =1.99,95 ％ confidence interval (CI):1.29-3.31],previous cerebral infarction (P =0.002,OR =2.86,95 ％ CI:1.43-5.72),surgery time (P =0.023,OR =0.90,95 ％ CI:0.49-1.67),deep hypothermic circulatory arrest (DHCA) time (P =0.019,OR =1.18,95 ％ CI:1.06-2.97),mechanical ventilation time (P =0.043,OR =1.17,95％ CI:1.00-1.37),arterial oxygen saturation(P =0.001,OR =2.77,95％ CI:1.51-5.11),intensive care unit (ICU) time (P =0.036,OR 1.10,95 ％ CI:1.10-1.21).The logistic stepwise regression analysis indicated that the independent perioperative risk factors of delirium included cerebrovascular accident history (P =0.017,OR =1.48,95 ％ CI:1.07-2.04),DHCA time (P =0.002,OR =2.86,95 ％ CI:1.43-5.72) and ICU duration time(P=0.030,OR =2.18,95％CI:1.07-4.44).Conclusion The independent risk factors of postoperative delirium include previous cerebral infarction,DHCA-time and ICU duration time.