葡萄糖波动与急性主动脉夹层患者术后谵妄的关系：一项观察性研究。
Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study.
机构信息
Department of Nursing, Union Hospital, Fujian Medical University, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Department of Nursing, Fujian Medical University, Fuzhou, China.
出版信息
J Cardiothorac Surg. 2021 Apr 15;16(1):82. doi: 10.1186/s13019-021-01456-4.
BACKGROUND
Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.
METHODS
We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.
RESULTS
A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195-1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704-0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%.
CONCLUSIONS
Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.
背景
血糖变异性与心脏手术后的不良预后相关，但在急性主动脉夹层患者中，血糖变异性与术后谵妄的关系尚不清楚。本研究旨在探讨急性主动脉夹层患者血糖变异性与术后谵妄的关系。
方法
我们前瞻性分析了 257 例患者，其中 103 例患者发生谵妄。根据是否发生谵妄，患者分为两组。观察指标为术后谵妄、重症监护病房住院时间和住院时间。采用多变量 Cox 竞争风险生存模型进行评估。
结果
共纳入 257 例患者，其中 103 例患者发生谵妄。两组在体重指数、心脏手术史、首次入院血糖、白细胞计数、急性生理学和慢性健康评估 II 评分、低氧血症、机械通气时间、重症监护病房住院时间方面存在统计学差异（P<0.05）。谵妄组的平均血糖（MBG）和血糖标准差（SDBG）均明显高于非谵妄组（P<0.05）。在模型 1 中，血糖标准差的调整后危险比（AHR）为 1.436（P<0.05）。在模型 2 中，调整混杂因素后，血糖标准差（AHR=1.418，95%CI=1.195-1.681，P<0.05）仍有统计学意义。SDBG 的曲线下面积为 0.763（95%CI=0.704-0.821，P<0.01）。灵敏度为 81.6%，特异度为 57.8%。
结论
血糖变异性与主动脉夹层手术后患者谵妄风险相关，高血糖变异性增加术后谵妄风险。
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