Fu Zuli, Xu Qian, Zhang Chiyuan, Bai Hui, Chen Xuliang, Zhang Yanfeng, Luo Wanjun, Lin Guoqiang
Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Int J Gen Med. 2021 Sep 21;14:5939-5948. doi: 10.2147/IJGM.S329689. eCollection 2021.
Post-operative delirium (POD) is a common complication after aortic surgery with poor outcomes. Blood pressure may play a role in the occurrence of POD. The study aimed to identify whether admission systolic blood pressure (SBP) level in the intensive care unit (ICU) is correlated with POD in acute Stanford type A aortic dissection (AAAD) patients undergoing aortic surgery.
We conducted a single-center retrospective cohort study enrolling consecutive 205 patients with acute type A aortic dissection undergoing aortic surgery. Patients were divided into 3 groups: low, normal, and high SBP level group. Outcomes of interest were POD, 30-day mortality and other complications including acute kidney injury, cardiac complications, spinal cord ischemia, stroke, and pneumonia. Confusion Assessment Method for Intensive Care Unit (CAM-ICU) method was used to assess POD. Univariate and multivariate logistic regression, Cox regression, and subgroup analysis were performed to uncover the association between SBP and POD.
The mean age of these patients was 51±16 years old. Thirty-six patients (17.6%) developed POD. Patients with high admission SBP were more likely to develop POD (P < 0.01). Univariate analysis showed that high admission SBP was associated with a higher risk of POD among AAAD patients (OR, 3.514; 95% CI, 1.478-8.537, P < 0.01). Multivariate logistic regression model confirmed that high SBP was an independent predictor of POD. Subgroup analysis indicated that patients with anemia and high admission SBP were at higher risk of POD.
High admission SBP was positively associated with the incidence of POD in AAAD patients who underwent surgical repair in ICU.
术后谵妄（POD）是主动脉手术后常见的并发症，预后较差。血压可能在POD的发生中起作用。本研究旨在确定重症监护病房（ICU）入院时的收缩压（SBP）水平与接受主动脉手术的急性Stanford A型主动脉夹层（AAAD）患者的POD是否相关。
我们进行了一项单中心回顾性队列研究，纳入连续205例接受主动脉手术的急性A型主动脉夹层患者。患者分为3组：低SBP水平组、正常SBP水平组和高SBP水平组。感兴趣的结局包括POD、30天死亡率和其他并发症，如急性肾损伤、心脏并发症、脊髓缺血、中风和肺炎。采用重症监护病房意识模糊评估法（CAM-ICU）评估POD。进行单因素和多因素逻辑回归、Cox回归及亚组分析，以揭示SBP与POD之间的关联。
这些患者的平均年龄为51±16岁。36例患者（17.6%）发生了POD。入院时SBP高的患者更易发生POD（P<0.01）。单因素分析显示，AAAD患者中，入院时SBP高与POD风险较高相关（OR，3.514；95%CI，1.478 - 8.537，P<0.01）。多因素逻辑回归模型证实，高SBP是POD的独立预测因素。亚组分析表明，贫血且入院时SBP高的患者发生POD的风险更高。
在ICU接受手术修复的AAAD患者中，入院时高SBP与POD的发生率呈正相关。
