急性A型主动脉夹层患者术后谵妄发生的危险因素分析
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(深圳市孙逸仙心血管医院心血管外科, 广东省深圳市 520018)

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周楚芝,硕士研究生,主治医师,主要研究方向为心脏及大血管围术期管理,E-mail为zhouchuzhi@126.com。杨建安,硕士,主任医师,硕士研究生导师,主要研究方向为急性主动脉夹层和胸腹主动脉瘤的开放和介入治疗。

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Analysis of Risk Factors for Postoperative Delirium in Patients with Acute Type A Aortic Dissection
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Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, Guangdong 520018, China)

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    摘要:

    目的 探讨急性主动脉夹层患者术后谵妄发生的相关危险因素。方法 回顾性分析173例急性A型主动脉夹层患者的围术期临床资料,其中男151例,女22例,年龄45.4±10.3岁。根据患者术后是否出现谵妄,分为谵妄组与非谵妄组,分析术后谵妄发生的独立危险因素。结果 全组出现术后谵妄共72例,发生率为41.6%。单因素及多因素Logistic回归分析显示,深低温停循环时间(OR=11.17,95%CI为2.61~43.08)、术后最低氧合指数(OR=2.86,95%CI为1.43~5.72)、机械通气时间(OR=4.52,95%CI为1.36~15.59)、高钠血症(OR=3.51,95%CI为1.03~8.37)、咪达唑仑用量(OR=1.48,95%CI为1.07~2.04)是Stanford A型主动脉夹层患者术后谵妄的独立危险因素。结论 术后谵妄在Stanford A 型主动脉夹层患者术后中有较高的发生率,深低温停循环时间、术后最低氧合指数、咪达唑仑用量、机械通气时间、高钠血症是主动脉夹层患者术后谵妄发生的独立危险因素。

    Abstract:

    Aim To study the incidence rate and risk factors of postoperative delirium in patients with acute aortic dissection. Methods The perioperative clinical data of 173 patients with acute type A aortic dissection were retrospectively analyzed, including 151 males and 22 females, aged 45.4±10.3 years old. According to the appearance of postoperative delirium, patients were divided into delirium and non-delirium group, and the independent risk factors for postoperative delirium were analyzed. Results There were 72 cases with postoperative delirium in all of the patients, the incidence rate was 41.6%. Univariate and multivariate Logistic analysis showed that deep hypothermic circulatory arrest time (OR=11.7,5%CI was 2.61~43.08), the lowest postoperative oxygenation index (OR=2.6,5%CI was 1.43~5.72), duration of mechanical ventilation (OR=4.2,5%CI was 1.36~15.59), hypernatremia (OR=3.1,5%CI was 1.03~8.37), the amount of midazolam (OR=1.8,5%CI was 1.07~2.04) were independent risk factors of postoperative delirium in patients with Stanford A aortic dissection. Conclusions The incident rate of postoperative delirium of Standford A aortic dissection patient is relatively high, deep hypothermic circulatory arrest time, the lowest postoperative oxygenation index, midazolam dosage, duration of mechanical ventilation and hypernatremia are independent risk factors of postoperative delirium in patients with aortic dissection.

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周楚芝,杨建安,温隽珉,姜妮,张志娴,刘希伶,冯东杰,陈伟新.急性A型主动脉夹层患者术后谵妄发生的危险因素分析[J].中国动脉硬化杂志,2016,24(12):1253~1257.

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  • 收稿日期:2016-07-15
  • 最后修改日期:2016-09-14
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  • 在线发布日期: 2017-02-09