心脏手术后谵妄的危险因素：一项历史队列研究，概述体外循环的影响。
Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass.
机构信息
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Can J Anaesth. 2017 Nov;64(11):1129-1137. doi: 10.1007/s12630-017-0938-5. Epub 2017 Jul 17.
PURPOSE
Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium.
METHODS
We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any postoperative positive Confusion Assessment Method for the Intensive Care Unit exam during the intensive care unit stay. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders.
RESULTS
During the study period, 2,280 patients underwent elective CABG surgery, with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). Exposure to CPB showed a significant independent association with delirium. Patients exposed to CPB for 142 min (90 percentile of CPB duration) vs those exposed for 54 min (10 percentile) had an adjusted relative risk (RR) of delirium of 2.18 (95% confidence interval [CI], 1.39 to 3.07; P = 0.002) vs a RR of 1.51 (95% CI, 0.92 to 2.29; P = 0.10), respectively.
CONCLUSIONS
The use and duration of cardiopulmonary bypass were associated with an increased risk of delirium in patients undergoing CABG surgery.
TRIAL REGISTRATION
www.clinicaltrials.gov , NCT02548975. Registered 4 September 2015.
目的
体外循环（CPB）会引起明显的炎症反应，从而增加谵妄的风险。我们假设，冠状动脉旁路移植术（CABG）期间暴露于 CPB 会增加谵妄的风险。
方法
我们回顾了我们医疗中心的两个数据库中的临床数据——心脏外科围手术期结局数据库和胸外科医生协会数据库。研究纳入了 2009 年 11 月 1 日至 2015 年 9 月 30 日期间择期行 CABG 手术（体外循环和非体外循环）的患者。术后 ICU 期间任何术后阳性 ICU 意识模糊评估方法检查的患者均被诊断为谵妄。我们进行了逻辑回归分析，以确定 CPB 暴露与调整了预定风险因素和潜在混杂因素后的谵妄之间的关联。
结果
在研究期间，2280 例患者接受了择期 CABG 手术，其中 384 例（16.9%）患者暴露于 CPB。451 例（19.8%）患者被诊断为谵妄。CPB 暴露与谵妄显著独立相关。CPB 持续时间为 142 分钟（CPB 持续时间的 90 百分位数）的患者与持续时间为 54 分钟（CPB 持续时间的 10 百分位数）的患者相比，调整后的谵妄相对风险（RR）为 2.18（95%置信区间[CI]，1.39 至 3.07；P=0.002），RR 为 1.51（95%CI，0.92 至 2.29；P=0.10）。
结论
在接受 CABG 手术的患者中，CPB 的使用和持续时间与谵妄风险的增加相关。
试验注册
www.clinicaltrials.gov，NCT02548975。2015 年 9 月 4 日注册。
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