Zhu K B, Ye X Z, Chen L, Zhi H, Ren L Q, Ma G S
Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Apr 24;44(4):338-41. doi: 10.3760/cma.j.issn.0253-3758.2016.04.012.
To evaluate the incidence and risk factors of postoperative delirium in patients post permanent pacemaker implantation.
Patients underwent permanent pacemaker implantation in our department from September 2013 to February 2015 were included in this study. Delirium was measured by the confusion assessment method on the first three postoperative days. All the patients were divided into the postoperative delirium group and the non-delirium control group according to whether new onset delirium was diagnosed. Risk factors significantly associated with postoperative delirium detected by univariate analysis were entered into multivariable analysis to define the independent predictors of postoperative delirium.
A total of 225 patients were enrolled in this study. The incidence of postoperative delirium was 5.3%. Patients developing postoperative delirium were older ((83±5) years vs. (74±11) years, P=0.002), had a significantly higher incidence of blood pressure fluctuations (58.3% (7/12) vs. 4.7% (10/213), P<0.001), hyponatremia (25.0% (3/12) vs. 5.2% (11/213), P=0.030) and had higher systolic blood pressure ((157±35) mmHg vs. (136±22)mmHg, 1 mmHg=0.133 kPa, P=0.007). However, patients developing postoperative delirium had lower preoperative average heart rate ( (47±18)bpm vs. (58±15)bpm, P=0.007). Multiple regression analysis showed that advanced age (OR= 2.984, 95% CI: 1.226-7.624, P=0.016) and blood pressure fluctuations (OR=27.393, 95% CI: 6.735-111.417, P<0.001) are the independent risk factors for pacemaker patients with postoperative delirium.
Advanced age and blood pressure fluctuations are independent risk factors of postoperative delirium in patients post permanent pacemaker implantation.
评估永久性起搏器植入术后患者术后谵妄的发生率及危险因素。
纳入2013年9月至2015年2月在我科接受永久性起搏器植入术的患者。术后前三天采用意识模糊评估法测量谵妄情况。根据是否诊断为新发谵妄，将所有患者分为术后谵妄组和非谵妄对照组。单因素分析检测到的与术后谵妄显著相关的危险因素纳入多变量分析，以确定术后谵妄的独立预测因素。
本研究共纳入225例患者。术后谵妄的发生率为5.3%。发生术后谵妄的患者年龄较大（（83±5）岁 vs.（74±11）岁，P = 0.002），血压波动发生率显著更高（58.3%（7/12） vs. 4.7%（10/213），P < 0.001），低钠血症发生率更高（25.0%（3/12） vs. 5.2%（11/213），P = 0.030），收缩压更高（（157±35）mmHg vs.（136±22）mmHg，1 mmHg = 0.133 kPa，P = 0.007）。然而，发生术后谵妄的患者术前平均心率较低（（47±18）次/分 vs.（58±15）次/分，P = 0.007）。多因素回归分析显示，高龄（OR = 2.984，95% CI：1.226 - 7.624，P = 0.016）和血压波动（OR = 27.393，95% CI：6.735 - 111.417，P < 0.001）是永久性起搏器植入术后患者发生术后谵妄的独立危险因素。
高龄和血压波动是永久性起搏器植入术后患者术后谵妄的独立危险因素。
