心脏术后谵妄的原因分析与处理对策

目的：分析心脏术后发生谵妄（PD）的围术期主要危险因素以及针对性的处理方法。方法：选择2009年9月至2011年9月华中科技大学同济医学院附属同济医院的230例心脏手术患者作为研究对象，根据CAM—ICU量表评测分为PD组和非PD组，分析18个围术期危险因素与术后PD的相关性．结果：230例患者中发生PD59例（PD组），未发生PD171例（非PD组）。两组ASA分级、手术级别、术中严重体液丢失、性别、体外循环总时间、高钠、药物使用和睡眠障碍比较，差异有统计学意义（P〈0．05）；Logistic回归分析结果显示，女性、ASA≥III级、手术级别〉III级、术中严重体液丢失、体外循环总时间、术后血钠〉145mm01／L、术后疼痛、硝普钠使用〉3d、睡眠障碍是心脏术后发生PD的特异性危险因素。，结论：心脏术后PD特异性的高危因素主要有性别、体外循环总时间、高钠、药物使用和睡眠障碍．谵妄的诊断可参考相关量表，根据可能的危险因素作相应处理可取得较好的近期疗效。

Etiologies and treatment strategies for delirium following cardiac surgery

Objective： To examine the risk factors and treatment strategies for delirium following cardiac surgery. Methods： We enrolled 230 patients scheduled for cardiac operation between September 2009 and September 2011 in Affiliated Tongji Hospital of Huazhong University of Science and Technology who were allocated to group PD and non-PD according to CAM-ICU scale. This entailed analysis on the correlation between 18 respective postoperative risk factors and delirium. Results： Of 230 patients enrolled in the study, 59 were diagnosed as having PD （group PD） and 171 did not evidence the presence of PD （group non-PD）. The between-group differenee in ASA score, surgical grading, the rate of severe loss of body fluid, gender, the total duration of extracorporeal circulation, elevated level of serum sodium, drug usage and sleep disorders was significanl （ all P 〈 0.05）. Logistic regression analysis showed that being female, having ASA grading of III or more or a surgical grading of IlI or more, the presence of severe loss of body fluid, increased duration of extracorporeal circulation, serum sodium of 145 mmol/L or more, presence of postoperative pain, sodium nitroprusside use of 3 days or more and presence of postoperative sleep disorders were independent risk factors of delirium following cardiac surgery. Conclusion ： Gender, the total duration of extracorporeal circulation, elevated levels of serum sodium, drug usage and sleep disorders are risk factors for delirium following cardiac surgery, the diagnosis of which could be based on the scales. Management according to potential risk factors may be associated with preferable therapeutic outcomes.