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1.
Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery 总被引:1,自引:0,他引:1
STUDY OBJECTIVES: To identify the typical duration of postoperative mechanical ventilation following coronary artery bypass graft surgery (CABG), and to identify risk factors for prolonged postoperative ventilation. DESIGN: Retrospective study of 4,863 consecutive patients using univariate and multivariate survival analysis to identify independent risk factors. SETTING: Saint Thomas Hospital, Nashville, TN, a 575-bed, academically affiliated, regional referral hospital specializing in cardiovascular diseases. PATIENTS: All patients undergoing CABG in our hospital from January 1, 1996, to December 31, 1997. INTERVENTIONS: None. Measurements and results: Duration of mechanical ventilation and mortality were measured. More than 94% of the patients were extubated in the first 3 days following surgery, 4% more were extubated from postoperative days 4 to 14, and almost 2% were receiving ventilation for > 14 days. Those risk factors that reflect preoperative medical instability, especially cardiac or respiratory insufficiency, were associated with the highest incidence of prolonged postoperative mechanical ventilation and for operative mortality. The Society of Thoracic Surgeons-predicted mortality estimate was the best single independent predictor for prolonged postoperative ventilation. CONCLUSIONS: Typically, patients can be expected to be extubated within 3 days after CABG. Certain preoperative comorbidities, especially preoperative cardiac or respiratory instability, are predictive of prolonged postoperative mechanical ventilation. 相似文献
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目的 分析冠状动脉旁路移植术后低氧血症发生的危险因素,探讨其预防和治疗方法.方法 回顾性分析我院198例冠状动脉旁路移植术(CABG)患者,男性140例,女性58例,年龄40~84(66.36±9.29)岁.机械通气(FiO2>45%)或面罩给氧(氧流量>6 L/min),术后PaO2低于[102-(0.33×年龄)]mm Hg者,确诊为低氧血症,对其术前、术中、术后相关因素进行单因素及多因素回归分析.结果 术后低氧64例,低氧发生率32.3%,成功纠正低氧60例,余4例出现多器官功能衰竭死亡,纠治率93.8%.术前、术中、术后单因素分析有统计学意义的因素包括吸烟史、糖尿病病史、术后胸腔积液、术后肺部感染、呼吸机辅助通气时间、血管病变根数、术后24h引流量、RBC输注量、术中液体入量、手术时间、主动脉阻断时间、体外循环时间和术前PaO2.多因素回归分析CABG术后低氧血症的独立危险因素有:术后肺部感染(OR=10.906,95%CI3.082~38.592)、血管病变支数(OR=3.432,95%CI 1.552~7.590)、吸烟史(OR =2.385,95%CI 1.181~4.815)、糖尿病史(OR=2.542,95%CI1.253~5.157),预测强度依次递减(P<0.05).结论 充分认识CABG术后低氧血症的危险因素,合理的围术期处理可有效防治CABG术后低氧. 相似文献
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目的:探讨冠状动脉旁路移植术(CABG)后脱呼吸机时间延迟的危险因素。方法:采用病例对照研究方法,取宜昌市第一人民医院重症医学科2008年1月~2012年1月CABG后的临床资料完整全部病例患者为研究对象,脱呼吸机时间延迟病例为病例组(15例),取同期同科室的CABG后脱呼吸机时间无延迟者为对照组(53例)。结果:CABG后脱呼吸机时间延迟单因素分析结果:术后低心排、术后循环衰竭、术后肾功衰竭、慢性阻塞性肺部疾病(COPD)、糖尿病、术后住ICU时间延迟。脱机时间延迟的独立的危险因素是: 术后低心排[OR 33.85,OR95.0%CI (1.61-711.35)];术后肾功衰竭[OR 6.98,OR95.0%CI(1.00-48.56];COPD[OR 12.35,OR95.0%CI(1.09-139.35)] (均P<0.05)。结论:CABG后脱呼吸机时间延迟独立的危险因素是: 术后低心排、术后肾功衰竭、COPD。 相似文献
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Min Ge Zhigang Wang Tao Chen Yongqing Cheng Jiaxin Ye Lichong Lu Cheng Chen Dongjin Wang 《Journal of thoracic disease》2021,13(2):735
BackgroundThis study aimed to identify risk factors for prolonged mechanical ventilation (PMV) and its association with disease prognosis following acute DeBakey type I aortic dissection surgery.MethodsA total of 582 patients who received emergency surgery for acute DeBakey type I aortic dissection from 2014 to 2018 were enrolled in this study. Mechanical ventilation period after surgery longer than 48 hours was defined as postoperative PMV. Multiple logistic regression analysis was used to identify risk factors for PMV. This study also compared short- and long-term outcomes in patients who developed PMV with patients who did not develop this complication. To identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted.ResultsAmong all enrolled patients, 259 (44.5%) received PMV treatment. Our data suggested that the length of intensive care unit and hospital stay were longer for patients who received PMV treatment. Thirty-day mortality was also higher in patients with PMV than in patients without PMV. Elevated leukocyte count and increased serum cystatin C level upon admission, lower preoperative platelet count and longer cardiopulmonary bypass (CPB) duration were identified as risk factors for PMV. Interestingly, our data suggested that there was no significant difference of survival rate between patients with or without PMV history.ConclusionsPMV after DeBakey type I aortic dissection repair surgery was a common complication and associated with increased short-term mortality rate but did not affect long-term mortality rate. Elevated preoperative leukocyte count, increased preoperative serum cystatin C level, lower preoperative platelet count and longer CPB duration were risk factors for PMV. 相似文献
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RATIONALE: After the introduction of autotransfusion of shed mediastinal blood following cardiac surgery, the incidence of mediastinitis increased. The role of autotransfusion in the increased occurrence of this serious complication was examined. METHODS: Using a case-control design, the preoperative, intraoperative, and postoperative characteristics of 11 patients with mediastinitis were compared to those of 33 randomly selected patients undergoing cardiac surgery between September 1, 2000, and April 15, 2001 (control subjects). RESULTS: Patients with mediastinitis were significantly more likely to have a body mass index > 30 (unadjusted odds ratio [OR], 9.9; 95% confidence interval [CI], 2.3 to 42.5), to have received antibiotic therapy during the 2 weeks prior to cardiac surgery (OR, 12.0; 95% CI, 1.1 to 131), or to have required re-exploration within 24 h of the original operation (OR, 8.3; 95% CI, 1.8 to 39). Patients with mediastinitis had 3.4 known risk factors for mediastinitis, compared to only 1.4 risk factors per control subject (p = 0.0001), and longer duration of autotransfusion. After adjustment for other risk factors, autotransfusion for > 6 h was significantly associated with the development of mediastinitis (adjusted OR, 11.9; 95% CI, 1.4 to 97.2). CONCLUSION: Retransfusion of shed mediastinal blood for > 6 h after cardiac surgery was an independent risk factor for mediastinitis. 相似文献
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目的探讨婴幼儿先天性心脏病(先心病)心内直视术后呼吸机相关性肺炎(VAP)的高危因素。方法回顾性分析2006年1月至2008年12月间入住浙江大学医学院儿童医院SICU的143例心内直视术后机械通气时间≥48h的先心病婴幼儿的病历资料。将143例婴幼儿分为两组:发生VAP的59例为VAP组,未发生VAP的84例为对照组。以性别、疾病类型、生长发育情况、贫血、血清球蛋白水平、术前抗生素应用情况、生长发育、机械通气时间、再插管、H2受体抑制剂或制酸剂应用等为预想危险因素进行单因素及多因素分析,明确婴幼儿心内直视术后与VAP相关的危险因素。结果婴幼儿先心病心内直视术后VAP的发生率为41.3%。单因素分析发现术前抗生素使用、体外循环(CPB)时间、机械通气时间、再插管、H2受体抑制剂或制酸剂应用、术后低心排、术后合并败血症这7个因素与VAP有关(P〈0.05)。多因素logistic回归分析显示术前抗生素使用、机械通气时间、再插管、H2受体抑制剂或制酸剂应用是婴幼儿先心病心内直视术后VAP的独立危险因素(P〈0.05)。结论婴幼儿先心病心内直视术后VAP发生率高,术前抗生素使用、机械通气时间、再插管、H2受体抑制剂或制酸剂应用是婴幼儿先心病心内直视术后VAP的独立危险因素,采取综合防治措施是控制VAP的最佳策略。 相似文献
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目的 分析瓣膜置换术后机械通气时间延长(≥48 h)的危险因素.方法 回顾我院2010年1月~2011年8月行心脏瓣膜置换术的518例患者的临床资料,并对术后机械通气辅助呼吸时间延长(≥48 h)的危险因素进行分析.结果 手术后机械通气时间超过48 h的患者72例,发生率13.9%.单因素分析结果表明,患者的年龄、心功能分级、术前血浆BNP水平、射血分数、肺动脉收缩压、同期行冠状动脉旁路移植手术、主动脉内球囊反搏支持、体外循环时间、主动脉阻断时间、置换瓣膜的数量、术后使用多巴胺≥10 μg/( kg·min)以及术后使用肾上腺素与患者术后机械通气时间延长相关(P<0.05或P<0.01),上述因素进入二元逐步Logistic回归分析,结果显示患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg·min)与术后机械通气时间延长独立相关(P<0.05或P<0.01).结论 瓣膜置换术后机械通气时间延长的影响因素较多,其中患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg·min)是患者术后机械通气时间延长的独立危险因素. 相似文献
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目的探讨心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的危险因素,为制订心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的防治措施提供依据。方法采用回顾性病例对照研究和非条件logistic多元回归分析方法,收集宜昌市第一人民医院重症医学科2008年1月至2012年1月心脏瓣膜病换瓣术后的71例患者资料,33例住ICU延迟脱离呼吸机患者与脱呼吸机时间无延迟的38例患者进行对照研究。结果心脏瓣膜病换瓣术后住ICU脱呼吸机时间延迟发生率为46.47%。心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的危险因素有术后低心排、术后。肾功能衰竭、年龄≥50岁、ST—T改变、住ICU〉5d等。心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的独立危险因素有:术后低心排(OR=5.329,95%CI1.682-16.881)、术后肾功能衰竭(OR=3.163,95%CI1.007-9.931)。结论心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的独立危险因素是术后低心排和肾功能衰竭。明确心脏瓣膜病换瓣术后住ICU延迟脱离呼吸机的危险因素,以缩短心脏瓣膜病换瓣术后呼吸机机械通气时间。 相似文献
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目的 探讨冠状动脉旁路移植术(CABG)后延迟拔管的危险因素.方法 回顾性纳入2008年1月至2013年1月宜昌市第一人民医院重症医学科CABG术后全部患者,以延迟拔管术后机械通气(>48 h)者作为观察组,以术后无延迟拔管的患者作为对照.对潜在危险因素进行对比分析,并采用非条件logistic多元回归分析.结果 共收治CABG术后患者92例,其中延迟拔管患者24例,发生率为35.29%.单因素分析结果显示,低心排、近期心梗、IABP、急诊手术、再次手术、CRRT、术后住ICU时间延长是CABG术后延迟拔管的高危因素.Logistic多因素回归分析显示,术后低心排[优势比(OR)=11.809,95%可信区间(95%CI)为(2.61353.364)]是CABG术后延迟拔管的独立危险因素(P<0.05).结论 低心排是CABG术后延迟拨管的独立危险因素. 相似文献
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Ryan J. Butts MD Alexander R. Ellis MD Scott M. Bradley MD Thomas C. Hulsey PhD Andrew M. Atz MD 《Congenital heart disease》2012,7(4):387-391
Objective. To study the effects of duration of preoperative prostaglandin E1 (PGE) exposure on perioperative outcomes of the arterial switch operation in patients with transposition of the great arteries with an intact ventricular septum. Design. Retrospective chart review. Setting. Pediatric cardiac intensive care unit in a tertiary care children's hospital. Patients. All patients with transposition of the great arteries with an intact ventricular septum from 1995 to 2008. Outcome Measures. Inotropic score was calculated for all patients in the first 5 postoperative days and maximum inotropic score was recorded. Length of postoperative mechanical ventilation, fluid balance, mechanical ventilation time, as well as intensive care unit and hospital stay were recorded for all patients. Results. Study population included 59 patients, 41 (69%) underwent balloon atrial septostomy. PGE was used in 52 patients, median exposure of 59 hours, range 0 to 272 hours. Longer preoperative PGE exposure was associated with longer preoperative mechanical ventilation (P < .001). There was no association between preoperative PGE duration and cardiopulmonary bypass time, cross‐clamp time, or total hospital stay. Patients with longer preoperative PGE exposure had a lower postoperative inotrope score (10 vs. 15 P = .02). Conclusion. Greater preoperative PGE exposure was associated with prolonged preoperative mechanical ventilation. Longer PGE exposure was associated with lower postoperative inotrope requirements. Aggressive efforts to avoid or shorten PGE infusion duration may not be warranted in this population. 相似文献
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Shengwen Guo Yuanyuan Tong Liting Bai Peiyao Zhang Xin Duan Jinping Liu 《Congenital heart disease》2020,15(5):275-285
Objective: Serum ferritin has been identified as a prognostic marker in
patients with a variety of diseases. In the present study we aim to determine the
prevalence of risk factors and outcomes for hyperferritinemia in children undergoing cardiac surgery with cardiopulmonary bypass for congenital heart defects.
Methods: The serum ferritin levels of 457 children between the ages of twentyeight days and three years undergoing cardiopulmonary bypass surgery between
June 1, 2017 and June 1, 2018 were analyzed. The prevalence of early postoperative hyperferritinemia was investigated; hyperferritinemia was defined as a ferritin
level ≥250 ng/ml. Multivariable regression models including candidate risk
factors were constructed to determine the independent predictors of serum ferritin
levels post-bypass, analyzed as continuous variables (linear regression) and categorized variables (logistic regression). Multivariable logistic regression was
applied to assess the relationship between postoperative hyperferritinemia and a
composite of in-hospital mortality, acute kidney injury, extracorporeal life
support, prolonged postoperative hospital length of stay and prolonged postoperative mechanical ventilation. Results: Of the 457 included patients, frequency of
post-cardiopulmonary bypass hyperferritinemia was 59/457 (10.9%). In
multivariate logistic analyses, age [odds ratio (OR) 0.776/90 days], maximum
cardiopulmonary bypass flow [OR 1.031/(1 ml/kg)], cardiopulmonary bypass
duration (OR 1.095/10 mins) and preoperative hemoglobin [OR 1.207/(10 g/L)]
were significantly associated with early postoperative day 1 hyperferritinemia.
After risk adjustment, hyperferritinemia was independently associated with the
composite outcome (OR 6.373; 95%CI 2.863~14.184, p < 0.001), and improved
model discrimination, (AUC 0.868; 95%CI 0.821∼0.916) compared with basic
clinical prediction alone (AUC 0.840; 95%CI, 0.790∼0.890; △AUC = 0.0279,
p = 0.0218). Conclusion: In this study, we found early postoperative hyperferritinemia was relatively common in pediatric patients after cardiopulmonary
bypass. The occurrence of hyperferritinemia may help identify a population at risk
of unfavorable in-hospital outcome. 相似文献
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R Gaynes R Marosok J Mowry-Hanley C Laughlin K Foley C Friedman M Kirsh 《The Journal of infectious diseases》1991,163(1):117-121
Twenty cases of mediastinitis after coronary artery bypass graft operations in 1985-1987 were reviewed to determine risk factors. Two distinct clusters with a methicillin-resistant Staphylococcus aureus (MRSA) strain occurred in 1986. One resident was exposed to six cases but to only 5 of 24 controls (P less than .008). Cultures of his nares in January and November 1986 revealed the same MRSA strain as that of the cases. An attempt to eradicate the resident's nasal carriage of MRSA in January 1986 failed; eradication of his carrier state was achieved only after treatment with mupirocin. In a case-control study examining patients exposed to the resident, a prolonged duration of surgery (P less than .05) and a preoperative albumin level of less than 3.0 g/dl (P less than .009) were associated with mediastinitis with this MRSA. For the other 14 mediastinitis patients, who were not exposed to the resident, a preoperative albumin level of less than 3.0 g/dl was also a risk factor (8/14 cases vs. 8/43 controls, P less than .009). Thus, this study suggests that it is important to follow MRSA disseminators and to recognize that preoperative serum albumin levels are a risk factor for mediastinitis. 相似文献
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Jiang SP Li ZY Huang LW Zhang W Lu ZQ Zheng ZY 《World journal of gastroenterology : WJG》2005,11(24):3735-3741
AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery. METHODS: A total of 1 002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied. RESULTS: The overall incidence of PPC was 22.8% (228/ 1 002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR = 1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) =q/[1+e-(-3.488+0.039×+1.090×Rd+0.001×Rbc-0.0047×Alb+0.002×Lii+ 0.049×Lni+0.630×Lmv+0.070×Dat+1.168×a)]. 相似文献
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目的 分析DebakeyⅠ型主动脉夹层术后急性呼吸功能不全(acute respiratory insufficiency,ARI)的相关因素。方法39例DebakeyⅠ主动脉夹层患者在深低温停循环下行手术治疗。收集患者术前、术中可疑变量进行统计分析〔(年龄、性别、高血压病、吸烟史、体质量指数(BMI)、术前氧合指数、灌注不良综合征、发病至手术时间、术后24 h内输注红细胞及血浆量、胸膜破裂、术后24 h胸管引流量、体外循环(cardiopulmonary bypass,CPB)时间、深低温停循环(deep hypothermic circulatory arrest,DHCA)时间、主动脉阻断时间〕。先对上述变量进行单因素分析,再将单因素分析中有统计学意义的变量,代入Logistic回归模型中进行多因素分析。结果 入选呼吸功能不全患者30例,无呼吸功能不全患者9例。单因素分析结果显示吸烟史、BMI>25 kg/m2、术前氧合指数<300、手术距发病时间<2周、灌注不良综合征、CPB时间>160 min、术后24 h红细胞输入量>10 U、术后24 h血浆输入量>1 000 ml有统计学意义(P<0.05)。多因素Logistic 回归分析的结果显示,以下因素为术后发生ARI的独立危险因素:BMI>25 kg/m2(P<0.01);术前氧合指数<300(P<0.05);术前灌注不良综合征(P<0.01);术后24 h血浆输入量>1 000 ml(P<0.05);CPB时间>160 min(P<0.01)。结论 DebakeyⅠ主动脉夹层患者深低温停循环术后发生ARI的危险因素包括:BMI>25 kg/m2;术前氧合指数<300;术前灌注不良综合征;术后24 h血浆输入量>1 000 ml;CPB时间>160 min。 相似文献
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Predictive risk factors for delayed extubation in patients undergoing coronary artery bypass grafting 总被引:5,自引:0,他引:5
Prolonged mechanical ventilation increases hospitalization costs, airway and lung trauma, and stress. The objective of this
study was to elucidate patient characteristics and operative variables that predict delayed extubation in patients undergoing
coronary artery bypass grafting (CABG). The records of 167 patients who underwent CABG between 1994 and 1998 were examined
retrospectively. The patients were divided into early and delayed extubation groups. Putative factors affecting the duration
of intubation were included in a univariate analysis using the t-test and chi-squared test. A logistic regression model was then developed to determine the factors associated with delayed
extubation. Forty-four percent of the patients needed prolonged mechanical ventilation (more than 24 h). Univariate predictors
of delayed extubation (P < 0.05) were emergency surgery, preoperative use of an intra-aortic balloon pump (IABP), the duration of anesthesia, surgery,
cardiopulmonary bypass and aortic cross-clamping, the total volume of fentanyl, lowest rectal temperature, glucose level,
perioperative transfusion, bleeding, perioperative heart failure, perioperative insertion of IABP, postoperative transfusion,
cardiac index, inspired oxygen fraction (FiO2), arterial oxygen tension (PaO2), the PaO2/FiO2 ratio, and the volume of catecholamine. In the delayed extubation group, the intensive care unit stay was significantly longer
(P < 0.001) and re-exploration was required more frequently (P = 0.004). Excellent prediction was provided by a model consisting of six variables: age, duration of surgery, perioperative
heart failure, glucose level, postoperative transfusion, and the PaO2/FiO2 ratio. These results suggest that decreasing the cardiopulmonary bypass time, maintaining a low glucose level during cardiopulmonary
bypass, and ensuring adequate perioperative hemostasis may help to avoid pulmonary dysfunction and delayed extubation. Moreover,
the PaO2/FiO2 ratio may be a useful predictor of delayed extubation in patients undergoing CABG.
Received: January 5, 2001 / Accepted: March 30, 2001 相似文献
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Naoyuki Kimura Masashi Tanaka Koji Kawahito Masamitsu Sanui Atsushi Yamaguchi Takashi Ino Hideo Adachi 《Circulation journal》2008,72(11):1751-1757
BACKGROUND: The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes. METHODS AND RESULTS: A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%). CONCLUSIONS: Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients. 相似文献
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Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. 总被引:10,自引:0,他引:10
D B Rolfson J E McElhaney K Rockwood B A Finnegan L M Entwistle J F Wong M E Suarez-Almazor 《The Canadian journal of cardiology》1999,15(7):771-776
OBJECTIVE: To determine the incidence and risk factors for delirium after coronary artery bypass graft (CABG) surgery. DESIGN: Prospective cohort. SETTING: Cardiac surgery units of a tertiary care hospital. PARTICIPANTS: Consecutive patients over age 65 years undergoing elective CABG surgery. Exclusion criteria included preoperative sensory or language barriers. INTERVENTIONS: Each patient was assessed within 24 h before surgery for baseline demographic, medical and functional data. Incident delirium (within four postoperative days) was diagnosed by a study physician. Nine potential risk factors for delirium were subjected to univariate and multivariate analysis. MAIN RESULTS: Of 75 consenting patients, three died during or soon after surgery and one was still comatose at follow-up. Of the remaining 71 participants, 23 (32%) experienced delirium. Those with delirium were more likely than those without delirium to have a history of a stroke (21% versus 4%, respectively, P=0.032) and to have had a longer duration of cardiopulmonary bypass (CPB) (113 mins versus 95 mins, respectively, P=0.025). A tendency to have experienced low cardiac output (83% versus 58%, respectively, P=0.061) postoperatively was also noted. Multivariate analysis confirmed past stroke and duration of cardiopulmonary bypass as risk factors. CONCLUSIONS: Delirium in the elderly after CABG surgery is common. Its occurrence may be predisposed by a history of a stroke and precipitated by a longer duration of CPB. 相似文献