| 付文,吕向妮,张霍,等.70岁以上患者冠状动脉旁路移植术后发生谵妄的影响因素研究[J].中国临床保健杂志,2021,24(6):771-775. |
| 70岁以上患者冠状动脉旁路移植术后发生谵妄的影响因素研究 |
| Investigation of patients over 70 years of age with delirium after coronary artery bypass grafting and its influencing factors |
| 投稿时间：2021-09-17 |
| DOI：10.3969/J.issn.1672-6790.2021.06.011 |
| 中文关键词: 冠状动脉分流术 谵妄 急性病生理学和长期健康评价 每搏输出量 认知功能障碍 老年人 |
| 英文关键词: Coronary artery bypass Delirium APACHE Stroke volume Cognitive dysfunction Aged 〖FL |
| 基金项目:国家自然科学基金项目(81870218) |
|
| 摘要点击次数: 1903 |
| 全文下载次数: 2651 |
| 中文摘要: |
| 目的 调查冠状动脉旁路移植术(CABG)患者(年龄＞70岁)术后谵妄发病情况,并探讨患者急性生理学和慢性健康状况评分(APACHE Ⅱ)、左心室射血分数(LVEF)与谵妄、认知功能障碍(POCD)的关联性。方法 选取2016年2月至2020年1月空军军医大学西京医院收治的356例年龄＞70岁的CABG患者,根据术后是否发生谵妄分为谵妄组(n=89)和无谵妄组(n=267),统计各年龄段、不同性别谵妄的发病率,比较两组临床资料、术中情况、机械通气时间、术后疼痛、ICU住院时间、血红蛋白、APACHE Ⅱ评分、认知障碍[蒙特利尔认知评估量表(MoCA)评分],探究谵妄发生的相关影响因素,分析APACHE Ⅱ评分、LVEF与POCD的关系及预测谵妄、POCD的效能。结果 356例年龄＞70岁的CABG患者术后谵妄发生率为25.00%；随着年龄、手术持续时间、ICU住院时间、APACHE Ⅱ评分增加和术前LVEF、MoCA评分降低,及存在脑梗死史,年龄＞70岁的CABG患者术后谵妄发生风险随之增加(P＜0.05)；年龄＞70岁的CABG患者术后MoCA评分与APACHE Ⅱ评分间存在负相关关系,与LVEF间存在正相关关系(P＜0.05)；APACHE Ⅱ评分联合LVEF预测谵妄、POCD的曲线下面积(AUC)分别为0.842、0.875,最佳预测敏感度、特异度分别为79.78%和77.44%、81.82%和93.59%。结论 年龄＞70岁的CABG患者术后存在一定谵妄发生率,APACHE Ⅱ评分、术前LVEF均为谵妄发生的影响因素,且与谵妄患者POCD显著相关,在预测谵妄、POCD方面具有较高应用价值。 |
| 英文摘要: |
| Objective To investigate the incidence of postoperative delirium in patients (age>70 years old) undergoing coronary artery bypass grafting (CABG),and to investigate the relationship between acute physiology and chronic health score (APACHE Ⅱ),left ventricular ejection fraction (LVEF),delirium and postoperative cognitive dysfunction (POCD).Methods From February 2016 to January 2020,356 CABG patients aged>70 years old were selected in Xijing Hospital and divided into delirium group (n=89) and non-delirium group (n=267) according to whether delirium occurred after surgery.The incidence of delirium of different ages and genders was counted,the clinical data,intraoperative conditions,mechanical ventilation time,postoperative pain,and ICU hospital stay,hemoglobin,APACHE Ⅱ score,and cognitive impairment (MoCA score) were compared between the two groups.The related factors influencing the occurrence of delirium were explored,and the relationship between APACHE Ⅱ score and LVEF and POCD was analyzed,and the efficacy of predicting delirium and POCD was analyzed.Results The incidence of postoperative delirium in 356 CABG patients over 70 years old was 25.00%.With the increase of age,operation duration,ICU hospital stay,APACHE Ⅱ score,preoperative LVEF,MoCA scores decreased,and a history of cerebral infarction,the risk of postoperative delirium in CABG patients over 70 years old increased (P<0.05).There was a negative correlation between the MoCA score and APACHE Ⅱ score in CABG patients aged>70 years old,and a positive correlation with LVEF (P<0.05);the area under the curve (AUC) of APACHE Ⅱ score combined with LVEF to predict delirium and POCD were 0.842 and 0.875,respectively.The best predictive sensitivity and specificity were 79.78%,77.44%,81.82%,and 93.59%,respectively.Conclusions There is a certain incidence of delirium in CABG patients who are older than 70 years old after surgery.APACHE Ⅱ score and preoperative LVEF are all influential factors in the occurrence of delirium,and are significantly related to POCD in patients with delirium.They have high application value in predicting delirium and POCD. |
|
查看全文
|
| 关闭 |
|
|
|