心脏手术后早期谵妄：老年（≥65 岁）和非常老年（≥80 岁）患者发生率和危险因素分析。
Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients.
机构信息
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland.
Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland.
出版信息
Clin Interv Aging. 2018 May 30;13:1061-1070. doi: 10.2147/CIA.S166909. eCollection 2018.
INTRODUCTION
Postoperative delirium is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. The aim of this study was to identify incidence and risk factors of delirium in elderly (≥65 years) and very elderly (≥80 years) patients undergoing major cardiac surgery.
MATERIALS AND METHODS
We performed a retrospective cohort analysis of prospectively collected data from a register of the cardiac surgery department of a tertiary referral university hospital between 2014 and 2016. Analysis was performed in two groups, ≥65 years and ≥80 years.
RESULTS
We analyzed 1,797 patients ≥65 years, including 230 (7.24%) patients ≥80 years. Delirium was diagnosed in 21.4% (384/1,797) of patients above 65 years, and in 33.5% (77/230) of octogenarians. Early mortality did not differ between patients with and without delirium. Intensive care unit (ICU) stay (<0.001), hospital stay (<0.001), and intubation time (=0.002) were significantly longer in patients undergoing cardiac surgery ≥65 years with delirium. According to multivariable analysis, <65 years, age (odds ratio [OR] 1.036, =0.002), low ejection fraction (OR 1.634, =0.035), diabetes (1.346, =0.019), and extracardiac arteriopathy (OR 1.564, =0.007) were found to be independent predictors of post-cardiac surgery delirium. Postoperative risk factors for developing delirium ≥65 years were atrial fibrillation (1.563, =0.001), postoperative pneumonia (OR 1.896, =0.022), elevated postoperative creatinine (OR 1.384, =0.004), and prolonged hospitalization (OR 1.019, =0.009).
CONCLUSION
Patients above 65 years of age with postoperative delirium have poorer outcome and are more likely to have prolonged hospitalization and ICU stay, and longer intubation times, but 30-day mortality is not increased. In our study, eight independent risk factors for development of post-cardiac surgery delirium were age, low ejection fraction, diabetes, extracardiac arteriopathy, postoperative atrial fibrillation, pneumonia, elevated creatinine, and prolonged hospitalization time.
简介
术后谵妄是心脏手术后常见的并发症，与死亡率、发病率和长期认知功能障碍增加有关。本研究的目的是确定行大心脏手术的老年（≥65 岁）和超高龄（≥80 岁）患者中发生谵妄的发生率和危险因素。
材料和方法
我们对 2014 年至 2016 年期间在一所三级转诊大学医院心脏外科登记处前瞻性收集的数据进行了回顾性队列分析。分析分为≥65 岁和≥80 岁两组进行。
结果
我们分析了 1797 名≥65 岁的患者，其中 230 名（7.24%）患者≥80 岁。≥65 岁患者中，21.4%（384/1797）诊断为谵妄，80 岁患者中，33.5%（77/230）诊断为谵妄。谵妄患者与无谵妄患者的早期死亡率无差异。行心脏手术≥65 岁且发生谵妄的患者 ICU 入住时间（<0.001）、住院时间（<0.001）和插管时间（=0.002）显著延长。多变量分析显示，<65 岁、年龄（比值比[OR]1.036，=0.002）、低射血分数（OR 1.634，=0.035）、糖尿病（1.346，=0.019）和心脏外动脉疾病（OR 1.564，=0.007）是心脏手术后发生谵妄的独立预测因素。≥65 岁患者发生术后谵妄的术后危险因素为心房颤动（1.563，=0.001）、术后肺炎（OR 1.896，=0.022）、术后肌酐升高（OR 1.384，=0.004）和住院时间延长（OR 1.019，=0.009）。
结论
术后发生谵妄的≥65 岁患者预后较差，更有可能延长住院时间和 ICU 入住时间，以及延长插管时间，但 30 天死亡率并未增加。在我们的研究中，术后发生心脏手术后谵妄的 8 个独立危险因素为年龄、低射血分数、糖尿病、心脏外动脉疾病、术后心房颤动、肺炎、肌酐升高和住院时间延长。
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