Department of Surgical Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
Department of Geriatric Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China.
J Cardiothorac Surg. 2024 Feb 22;19(1):106. doi: 10.1186/s13019-024-02568-3.
The aim of this study was to identify the risk factors for postoperative delirium (POD) in elderly patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).
Elderly patients undergoing elective heart valve surgery with CPB in The First Affiliated Hospital of Wenzhou Medical University between March 2022 and March 2023 were selected for this investigation. They were divided into a POD group and a non-POD group. Their baseline information was collected and recorded, and the patients were subjected to neurocognitive function assessment using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales before surgery. We also recorded their intraoperative indicators such as duration of surgery, duration of CPB, duration of aortic cross-clamp, blood transfusion, and postoperative indicators such as duration of mechanical ventilation, postoperative 24-hour drainage volume, and pain score. Regional cerebral oxygen saturation was monitored intraoperatively by near-infrared spectroscopy based INVOS5100C Regional Oximeter. Patients were assessed for the occurrence of POD using Confusion Assessment Method for the Intensive Care Unit, and logistic regression analysis of risk factors for POD was performed.
The study finally included 132 patients, with 47 patients in the POD group and 85 ones in the non-POD group. There were no significant differences in baseline information and preoperative indicators between the two groups. However, marked differences were identified in duration of surgery, duration of CPB, duration of aortic cross-clamp, duration of postoperative mechanical ventilation, postoperative length of stay in cardiac intensive care unit, postoperative length of hospital stay, intraoperative blood transfusion, postoperative pain score, and postoperative 24-hour drainage volume between the two groups (p < 0.05). Additionally, the two groups had significant differences in rScO at each intraoperative time point and in the difference of rScO from baseline at each intraoperative time point (p < 0.05). Multivariate logistic regression analysis showed that duration of surgery > 285 min (OR, 1.021 [95% CI, 1.008-1.035]; p = 0.002), duration of postoperative mechanical ventilation > 23.5 h (OR, 6.210 [95% CI, 1.619-23.815]; p = 0.008), and postoperative CCU stay > 3.5 d (OR, 3.927 [95% CI, 1.046-14.735]; p = 0.043) were independent risk factors of the occurrence of POD while change of rScO at T>50.5 (OR, 0.832 [95% CI 0.736-0.941]; p = 0.003) was a protective factor for POD.
Duration of surgery duration of postoperative mechanical ventilation and postoperative CCU stay are risk factors for POD while change of rScO at T is a protective factor for POD in elderly patients undergoing heart valve surgery with CPB.
本研究旨在确定体外循环（CPB）下心瓣膜手术老年患者术后谵妄（POD）的风险因素。
选择 2022 年 3 月至 2023 年 3 月在温州医科大学附属第一医院行择期 CPB 下心瓣膜手术的老年患者进行本研究。他们被分为 POD 组和非 POD 组。收集并记录他们的基线信息，并在手术前使用简易精神状态检查表和蒙特利尔认知评估量表对患者进行神经认知功能评估。我们还记录了他们的术中指标，如手术持续时间、CPB 持续时间、主动脉阻断时间、输血和术后指标，如机械通气持续时间、术后 24 小时引流量和疼痛评分。术中使用近红外光谱仪 INVOS5100C 区域血氧饱和度监测局部脑氧饱和度。使用重症监护病房意识模糊评估法对患者进行 POD 发生评估，并对 POD 的风险因素进行逻辑回归分析。
本研究最终纳入 132 例患者，其中 POD 组 47 例，非 POD 组 85 例。两组患者的基线信息和术前指标无统计学差异。然而，两组在手术持续时间、CPB 持续时间、主动脉阻断时间、术后机械通气持续时间、术后心脏重症监护病房住院时间、术后住院时间、术中输血、术后疼痛评分和术后 24 小时引流量方面存在显著差异（p<0.05）。此外，两组患者在每个术中时间点的 rScO 以及每个术中时间点 rScO 与基线的差异均有统计学意义（p<0.05）。多变量逻辑回归分析显示，手术持续时间>285 分钟（OR，1.021[95%CI，1.008-1.035]；p=0.002）、术后机械通气持续时间>23.5 小时（OR，6.210[95%CI，1.619-23.815]；p=0.008）和术后 CCU 住院时间>3.5 天（OR，3.927[95%CI，1.046-14.735]；p=0.043）是 POD 发生的独立危险因素，而 rScO 在 T>50.5 时的变化（OR，0.832[95%CI 0.736-0.941]；p=0.003）是 POD 的保护因素。
CPB 下心瓣膜手术老年患者中，手术持续时间、术后机械通气持续时间和术后 CCU 住院时间是 POD 的危险因素，而 rScO 在 T 时的变化是 POD 的保护因素。
