Guo Yating, Li Chengyang, Mu Yan, Wu Tingting, Lin Xiuxia
Department of Nursing, Zhangzhou Affiliated Hospital of Fujian Medical University and Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, Fujian, China.
College of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China.
J Clin Nurs. 2025 Sep;34(9):3811-3825. doi: 10.1111/jocn.17596. Epub 2024 Dec 9.
Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention.
To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB.
Prospective cohort design.
A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors.
A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031-1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246-2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851-0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000-1.001; p < 0.001) were independent predictors of POD.
The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD.
The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies.
No patient or public contribution.
谵妄是体外循环心脏手术后最常见且严重的并发症之一。全面评估术后谵妄（POD）的独立危险因素对于早期发现和预防至关重要。
调查接受体外循环心脏手术的成年患者中POD的发生率及独立相关因素。
前瞻性队列研究设计。
2022年10月至2023年12月在中国共纳入203例患者。采用 Richmond 躁动镇静量表（RASS）和重症监护病房意识模糊评估法（CAM-ICU）评估谵妄症状。本研究分析了POD的各种因素，包括人口统计学、身体、心理、社会、精神和环境方面。采用逻辑回归分析确定独立相关因素。
共有60.1%（n = 122）的患者发生POD。在这些病例中，86例（70.5%）为活动减退型谵妄，4例（3.3%）为活动亢进型谵妄，32例（26.2%）为混合型谵妄。高龄（比值比[OR]=1.069，95%置信区间[CI]：1.031 - 1.107；p < 0.001）、术前抑郁（OR = 1.847，95% CI：1.246 - 2.736；p = 0.002）、术后白蛋白水平（OR = 0.921，95% CI：0.851 - 0.997；p = 0.042）和机械通气时间（OR > 1.000，95% CI：1.000 - 1.001；p < 0.001）是POD的独立预测因素。
接受体外循环心脏手术患者的POD发生率较高。本研究确定高龄、术前抑郁、术后白蛋白水平和机械通气时间是POD的重要独立预测因素。
该研究结果凸显了提高临床警惕性和积极管理策略的迫切必要性。
无患者或公众参与。
