文章摘要
急性A型主动脉夹层患者术后谵妄的危险因素
Risk factors of postoperative delirium in patients with acute type A aortic dissection
  
DOI：10.12089/jca.2022.06.012
中文关键词: 急性A型主动脉夹层  术后谵妄  危险因素  脑氧饱和度
英文关键词: Acute type A aortic dissection  Postoperative delirium  Risk factors  Cerebral oxygen saturation
基金项目:江苏省临床医学科技专项基金（BE2017610）
作者单位E-mail
牛永胜 210006,南京医科大学附属南京医院/南京市第一医院重症医学科  
李莉 210006,南京医科大学附属南京医院/南京市第一医院重症医学科  
魏海燕 南京医科大学附属南京医院/南京市第一医院麻醉科  
黄福华 南京医科大学附属南京医院/南京市第一医院心胸外科  
章淬 210006,南京医科大学附属南京医院/南京市第一医院重症医学科 18951670283@163.com 
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中文摘要:
      
目的 分析急性A型主动脉夹层（AAD）患者发生术后谵妄（POD）的相关危险因素。
方法 回顾性分析2017年1月至2020年1月术后入ICU监护治疗的AAD手术患者110例，男74例，女36例，年龄≥18岁。根据术后5 d内是否发生POD将患者分为两组：POD组和非POD组。POD的评估采用ICU意识模糊评估法（CAM-ICU）进行。收集患者围术期指标，采用单因素Logistic回归分析AAD手术患者发生POD的相关因素，多因素Logistic回归分析AAD手术患者发生POD的独立危险因素。
结果 有32例（29.1%）患者发生POD。单因素Logistic回归分析结果显示，年龄、酗酒史、术前ALT、术后当天急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ）评分、入ICU 6 h内MAP、入ICU 6 h内局部脑氧饱和度（SctO2）是AAD手术患者发生POD的相关因素（P<0.05）。多因素Logistic回归分析结果显示，年龄增大（每增大1岁，OR=1.240， 95%CI 1.062~1.267，P=0.036）、酗酒史（OR=1.106， 95%CI 0.927~1.270，P=0.042）、入ICU 6 h内MAP（<65 mmHg，OR=1.326， 95%CI 0.863~1.974，P=0.016）和入ICU 6 h内SctO2（≤50%，OR=1.182， 95%CI 1.021~1.356，P=0.022）是AAD手术患者发生POD的独立危险因素。与非POD组比较，POD组ICU内AKI、MODS发生率明显升高，ICU停留时间明显延长（P<0.05）。两组术后大出血发生率、术后5 d内再次手术率、ICU内脑血管意外发生率、住院期间死亡率差异无统计学意义。
结论 年龄增大、酗酒史、术后早期低血压和低SctO2是AAD手术患者发生POD的独立危险因素。
英文摘要:
      
Objective To analyze the related risk factors of postoperative delirium (POD) in patients with acute type A aortic dissection (AAD).
Methods A total of 110 AAD patients (74 males and 36 females, aged ≥ 18 years) admitted to ICU after surgery from January 2017 to January 2020 were retrospectively analyzed. According to the occurrence of POD within 5 days after surgery, the patients were divided into two groups: POD group and non-POD group. POD was assessed by confusion assessment method intensive care unit (CAM-ICU). Perioperative indicators were collected and compared. The factors related to POD in patients undergoing AAD surgery were analyzed by univariate logistic regression, and the independent risk factors of POD in patients undergoing AAD surgery were analyzed by multivariate logistic regression.
Results The incidence of delirium was 29.1% (32 patients). Univariate logistic regression analysis showed that age, history of alcohol abuse, preoperative ALT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on postoperative day, MAP within 6 hours after ICU admission, and cerebral tissue oxygen saturation (SctO2) within 6 hours after ICU admission might be related risk factors for POD in AAD patients (P < 0.05). Multivariate logistic regression analysis showed that aging (for every one year increased, OR = 1.240, 95% CI 1.062-1.267, P = 0.036), history of alcohol abuse (OR = 1.106, 95% CI 0.927-1.270, P = 0.042), MAP within 6 hours after ICU admission (< 65 mmHg, OR = 1.326, 95% CI 0.863-1.974, P = 0.016), and SctO2 within 6 hours after ICU admission (≤ 50%, OR = 1.182, 95% CI 1.021-1.356, P = 0.022) were independent risk factors for POD in AAD patients. Compared with the non-POD group, the incidences of AKI and MODS in ICU were significantly higher, and the ICU stay was significantly longer in the POD group (P < 0.05). There was no significant difference in the incidence of postoperative massive bleeding, reoperation rate within 5 days after surgery, incidence of cerebrovascular accident in ICU, and in-hospital mortality between the two groups.
Conclusion Increased age, history of alcohol abuse, early postoperative hypotension, and low SctO2 are independent risk factors for POD in patients undergoing AAD surgery.
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