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心脏手术后患者术后谵妄的风险因素。

Risk factors for postoperative delirium in patients with cardiac surgery.

机构信息

Yeungnam University Medical Center, Daegu, Republic of Korea.

College of Nursing, Keimyung University, Daegu, Republic of Korea.

出版信息

Sci Prog. 2024 Jul-Sep;107(3):368504241266362. doi: 10.1177/00368504241266362.

Abstract

Patients admitted to the intensive care unit (ICU) after cardiac surgery are at high risk of delirium due to a variety of factors. This study aimed to identify the incidence of postoperative delirium in adult patients with cardiac surgery and its risk factors, such as characteristics of subjects, disease and treatment-related, as well as nursing-related characteristics. The study was performed on adult patients who underwent cardiac surgery at Y University Hospital in D city; a total of 195 patients met the inclusion criteria. The results of this study determined that 67 of 195 adult cardiac surgery patients had postoperative delirium, 53.7% of which occurred in the ICU and 46.3% in the general ward. Risk factors of postoperative delirium were postoperative symptoms of inflammation (odds ratio [OR] = 10.18, = 0.002), continuous renal replacement therapy application after surgery (OR = 9.05, = 0.006), postoperative sleep disorder (OR = 8.98, < 0.001), age (OR = 6.23, = 0.006), length of stay in the ICU (OR = 3.83, = 0.031), history of stroke (OR = 3.71, = 0.033), the number of postoperative catheter retention (OR = 1.53, = 0.065), Acute Physiology and Chronic Health Evaluation Ⅱ score (OR = 1.12, = 0.006), and time of operation (OR = 1.01, = 0.042). This study confirmed that after cardiac surgery, postoperative delirium occurred in patients during their ICU stay and after their transfer to a general ward. Considering that after cardiac surgery ICU-related factors affect the incidence of delirium in the general ward, there is a need for continuous monitoring of ICU-related factors after the patient gets transferred to a general ward.

摘要

术后 ICU 心脏手术后的患者由于多种因素,处于谵妄的高风险中。本研究旨在识别成人心脏手术后患者术后谵妄的发生率及其危险因素,如患者特征、疾病和治疗相关因素以及护理相关特征。该研究在 D 市 Y 大学医院进行,共纳入 195 名符合条件的成年心脏手术患者。本研究结果确定,195 名成年心脏手术患者中有 67 名患者发生术后谵妄,其中 53.7%发生在 ICU,46.3%发生在普通病房。术后谵妄的危险因素包括术后炎症症状(比值比 [OR] = 10.18,= 0.002)、术后应用连续肾脏替代治疗(OR = 9.05,= 0.006)、术后睡眠障碍(OR = 8.98,<0.001)、年龄(OR = 6.23,= 0.006)、ICU 住院时间(OR = 3.83,= 0.031)、中风史(OR = 3.71,= 0.033)、术后导管保留数量(OR = 1.53,= 0.065)、急性生理学和慢性健康评估Ⅱ评分(OR = 1.12,= 0.006)和手术时间(OR = 1.01,= 0.042)。本研究证实,心脏手术后,患者在 ICU 住院期间和转入普通病房后会发生术后谵妄。考虑到心脏手术后 ICU 相关因素会影响普通病房谵妄的发生率,因此需要在患者转入普通病房后对 ICU 相关因素进行持续监测。

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本文引用的文献

1
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Brain Sci. 2023 Dec 7;13(12):1682. doi: 10.3390/brainsci13121682.
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Perfusion. 2023 Nov;38(8):1545-1559. doi: 10.1177/02676591221119312. Epub 2022 Aug 19.
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Risk factors of postoperative delirium after cardiac surgery: a meta-analysis.
J Cardiothorac Surg. 2021 Apr 26;16(1):113. doi: 10.1186/s13019-021-01496-w.

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