Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, 210006, Nanjing, People's Republic of China.
BMC Anesthesiol. 2024 Nov 25;24(1):424. doi: 10.1186/s12871-024-02817-x.
Delirium is one of the most common neurological complications after cardiac surgery. The purpose of our study was to assess the relationship between perioperative blood pressure variability (BPV) and postoperative delirium (POD) in the patients undergoing cardiac surgery.
Adult patients received cardiac surgery and stayed in Cardiovascular Intensive Care Unit (ICU) for more than 24 h after surgery during the study period between June 2019 and December 2022 were included in this study. Baseline characteristics, perioperative hemodynamic variables and postoperative laboratory results of the cardiac patients were collected and analyzed. Perioperative BPV was quantified by calculating the standard deviation (SD) and average real variability (ARV) of blood pressure. Assessment of delirium was based on the mental status of the patients and CAM-positive. The relationship between perioperative BPV and POD was analyzed by LASSO and logistic regression using R (R package, 4.3.2).
The incidence of POD was 15.0% (324/2164) in the patients receiving cardiac surgery, and the average day for POD occurred at day 3 after surgery. Patients with POD had statistically lower levels of intraoperative mean blood pressure (P = 0.015) and blood pressure ARV (P < 0.001) as well as mean blood pressure at 24 h postoperatively (P = 0.003) when compared to those without. Whereas, ARV for systolic blood pressure (8.64 vs. 7.91 mmHg, P < 0.001), diastolic blood pressure (4.00 vs. 3.77 mmHg, P = 0.014) and mean blood pressure (5.23 vs. 4.94 mmHg, P = 0.001) at 24 h postoperatively was significantly higher in the patients with POD than those without. LASSO regression and further logistic regression revealed that intraoperative blood pressure ARV (OR:0.92, P < 0.001), mean central venous pressure (OR:1.05, P = 0.048) and ARV of systolic blood pressure (OR:1.17, P = 0.002) at 24 h postoperatively were independent risk factors for POD.
Perioperative ARV, especially postoperative high ARV exposure, was associated with POD in the patients receiving cardiac surgery. Maintaining a relatively stable blood pressure after cardiac surgery might be beneficial to avoid POD in those patients.
谵妄是心脏手术后最常见的神经并发症之一。我们的研究目的是评估心脏手术后患者围手术期血压变异性（BPV）与术后谵妄（POD）之间的关系。
在 2019 年 6 月至 2022 年 12 月期间，纳入在心脏手术后在心血管重症监护病房（ICU）中停留超过 24 小时的成年患者。收集并分析了心脏患者的基线特征、围手术期血流动力学变量和术后实验室结果。通过计算血压的标准差（SD）和平均实际变异性（ARV）来量化围手术期 BPV。谵妄评估基于患者的精神状态和 CAM 阳性。使用 R（R 包，4.3.2）通过 LASSO 和逻辑回归分析围手术期 BPV 与 POD 之间的关系。
接受心脏手术的患者中 POD 的发生率为 15.0%（324/2164），POD 发生的平均天数为术后第 3 天。与无 POD 的患者相比，有 POD 的患者术中平均血压（P=0.015）和血压 ARV（P<0.001）以及术后 24 小时平均血压（P=0.003）均统计学降低。而术后 24 小时收缩压（8.64 与 7.91mmHg，P<0.001）、舒张压（4.00 与 3.77mmHg，P=0.014）和平均血压（5.23 与 4.94mmHg，P=0.001）的 ARV 明显高于无 POD 的患者。LASSO 回归和进一步的逻辑回归显示，术中血压 ARV（OR：0.92，P<0.001）、术后 24 小时平均中心静脉压（OR：1.05，P=0.048）和术后 24 小时收缩压 ARV（OR：1.17，P=0.002）是 POD 的独立危险因素。
心脏手术后患者围手术期 ARV，尤其是术后高 ARV 暴露，与 POD 相关。心脏手术后保持相对稳定的血压可能有利于避免 POD。
