CAJ | 학술논문

目的：分析老年患者心脏术后住重症医学科期间谵妄的发生情况及相关危险因素。方法以南京医科大学附属南京医院2014年3月至5月期间行心脏手术的老年患者117例为研究对象进行回顾性分析，统计术后谵妄发生率，并用多因素logistic回归分析其相关因素。结果117例心脏术后老年患者中，27例（23.08%）术后发生谵妄。单因素分析结果显示，低左室射血分数（LVEF）值、机械通气时间、停留重症监护室（ICU）时间、输血、低钠血症、高钾血症和急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）与谵妄发生相关（P＜0.05）；多因素logistic回归分析显示，机械通气时间（P＝0.022），低LVEF值（P＝0.041），停留ICU时间（P＝0.031）和与术后谵妄的发生密切相关。结论研究认为，低LVEF值、长时间机械通气、停留ICU时间是心脏术后老年患者出现谵妄的危险因素。
목적：분석노년환자심장술후주중증의학과기간섬망적발생정황급상관위험인소。방법이남경의과대학부속남경의원2014년3월지5월기간행심장수술적노년환자117례위연구대상진행회고성분석，통계술후섬망발생솔，병용다인소logistic회귀분석기상관인소。결과117례심장술후노년환자중，27례（23.08%）술후발생섬망。단인소분석결과현시，저좌실사혈분수（LVEF）치、궤계통기시간、정류중증감호실（ICU）시간、수혈、저납혈증、고갑혈증화급성생리여만성건강평분Ⅱ（APACHE Ⅱ）여섬망발생상관（P＜0.05）；다인소logistic회귀분석현시，궤계통기시간（P＝0.022），저LVEF치（P＝0.041），정류ICU시간（P＝0.031）화여술후섬망적발생밀절상관。결론연구인위，저LVEF치、장시간궤계통기、정류ICU시간시심장술후노년환자출현섬망적위험인소。
Objective To analyze the incidence and risk factors of delirium after cardiac surgery in the elderly patients during hospitalization in intensive care unit (ICU). Methods Retrospective study was performed in a total of 117 patients (over 60 years old) undergoing heart surgery in Nanjing Hospital from March to May 2014. The incidence of delirium was documented during hospitalization. Multivariate logistic regression analysis was used to evaluate the related factors. Results Postoperative delirium occurred in 27 out of the 117 patients, with an incidence of 23.08%. Univariate analysis showed that delirium was associated with left ventricular ejection fraction (LVEF), duration of mechanical ventilation, length of stay in ICU, blood transfusions, hyponatremia, hyperkalemia, and score of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) (P<0.05). Based on multivariate logistic analysis, duration of mechanical ventilation (P=0.022), low LVEF (P= 0.041) and length of stay in ICU (P= 0.031) were closely associated with postoperative delirium. Conclusion Low LVEF, long time of mechanical ventilation, and long stay in ICU are risk factors for delirium in the elderly after cardiac surgery.