Ogata Yuko, Kobayashi Naoya, Yamauchi Masanori
Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba, Sendai 980-8575, Miyagi, Japan.
J Clin Med. 2022 Jun 9;11(12):3317. doi: 10.3390/jcm11123317.
Transcatheter aortic valve implantation (TAVI) is an effective treatment for severe aortic stenosis (AS); however, postoperative delirium (POD) can worsen patient outcomes. This study aimed to examine the risk factors for POD after TAVI, including possible intervening factors. We included 87 patients (mean age: 83) who underwent TAVI between May 2014 and September 2018. POD was defined by the presence or absence of delirium on ICU admission, assessed using the Confusion Assessment Method for the ICU. Factors that showed significant differences in the univariate analysis were analyzed using a multiple logistic regression analysis. In total, 31 patients (36%) had POD after ICU admission, and 56 (64%) did not. The preoperative frailty score and aortic valve opening area (AVA) were significant risk factors for POD. The multivariate analysis also showed that both factors were independent risk factors for POD (area under the receiver operating characteristic curve: 0.805). There were no significant differences in the number of ICU days. However, postoperative hospitalization was significantly longer in the POD group (19 (17-31) days vs. 16 (13-22) days; = 0.002). POD was associated with a narrow AVA and frailty; this suggests that frailty prevention interventions according to the AVA may be important.
经导管主动脉瓣植入术（TAVI）是治疗重度主动脉瓣狭窄（AS）的有效方法；然而，术后谵妄（POD）会使患者预后恶化。本研究旨在探讨TAVI术后发生POD的危险因素，包括可能的干预因素。我们纳入了2014年5月至2018年9月期间接受TAVI的87例患者（平均年龄：83岁）。POD根据重症监护病房（ICU）入院时是否存在谵妄来定义，采用ICU意识模糊评估方法进行评估。对单因素分析中显示出显著差异的因素进行多因素逻辑回归分析。总共有31例患者（36%）在ICU入院后发生了POD，56例（64%）未发生。术前衰弱评分和主动脉瓣开口面积（AVA）是POD的显著危险因素。多因素分析还显示这两个因素都是POD的独立危险因素（受试者工作特征曲线下面积：0.805）。ICU住院天数无显著差异。然而，POD组术后住院时间明显更长（19（17 - 31）天 vs. 16（13 - 22）天；P = 0.002）。POD与AVA狭窄和衰弱有关；这表明根据AVA进行衰弱预防干预可能很重要。
