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冠状动脉搭桥术后谵妄的发生率及诱发因素

Incidence and precipitating factors of delirium after coronary artery bypass grafting.

作者信息

Norkiene Ieva, Ringaitiene Donata, Misiuriene Irina, Samalavicius Robertas, Bubulis Rimas, Baublys Alis, Uzdavinys Giedrius

机构信息

Center of Anaesthesia, Intensive Care and Pain Management, Vilnius University Hospital, Santariskiu Clinics, Vilnius, Lithuania.

出版信息

Scand Cardiovasc J. 2007 Jun;41(3):180-5. doi: 10.1080/14017430701302490.

Abstract

OBJECTIVE

To analyze large contemporary patient population, undergoing on-pump coronary artery bypass grafting at our institution, and identify the prevalence and precipitating factors of delirium development.

DESIGN

Baseline demographics, operative data and postoperative outcomes of 1367 consecutive patients were recorded prospectively and analysed using multivariate logistic regression analysis, to determine independent predictors of postoperative delirium development.

RESULTS

Delirium was detected in 42 (3.07%) patients. Eight factors: age more than 65 years, peripheral vascular disease, Euroscore>/=5, preoperative IABP support, postoperative blood product usage and postoperative low cardiac output syndrome were independently predicting delirium development after coronary artery bypass procedures. Postoperative delirium was associated with significantly higher mortality rate (16.6% vs. 3.9%, p=0.013), prolonged mechanical ventilation time (9.2+/-3.1 vs. 5.05+/-7.6, p=0.04) and increased length of intensive care unit stay (6.8+/-4.9 vs. 2.0+/-2.7 days, p=0.001).

CONCLUSIONS

Delirium is a dangerous complication, prolonging intensive care unit stay and postoperative mortality. Factors associated with delirium development are advanced age, peripheral vascular disease, diminished cardiac function and blood product usage.

摘要

目的

分析我院当代大量接受体外循环冠状动脉搭桥术的患者群体,确定谵妄发生的患病率及诱发因素。

设计

前瞻性记录1367例连续患者的基线人口统计学资料、手术数据及术后结果,并采用多因素逻辑回归分析进行分析,以确定术后谵妄发生的独立预测因素。

结果

42例(3.07%)患者发生谵妄。八个因素:年龄大于65岁、外周血管疾病、欧洲心脏手术风险评估系统(Euroscore)≥5、术前主动脉内球囊反搏(IABP)支持、术后血液制品使用及术后低心排血量综合征是冠状动脉搭桥术后谵妄发生的独立预测因素。术后谵妄与显著更高的死亡率(16.6%对3.9%,p=0.013)、延长的机械通气时间(9.2±3.1对5.05±7.6,p=0.04)及重症监护病房住院时间延长(6.8±4.9对2.0±2.7天,p=0.001)相关。

结论

谵妄是一种危险的并发症,会延长重症监护病房住院时间及术后死亡率。与谵妄发生相关的因素为高龄、外周血管疾病、心功能减退及血液制品使用。

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