Stanford A型主动脉夹层患者术后谵妄的相关危险因素分析

摘要： 目的 分析StanfordA型主动脉夹层患者发生术后谵妄 （POD） 的相关危险因素， 指导临床实践。方法 回顾性分析天津市胸科医院2016年1月—2017年12月行手术治疗的118例StanfordA型主动脉夹层患者的临床资料，其中男81例、 女37例， 年龄 （55.0±10.3） 岁。根据患者术后是否出现谵妄分为POD组 （56例） 与非POD组 （62例）。收集患者术前、 术中、 术后的相关临床资料， 分别采用单因素及多因素Logistic回归分析发生POD的危险因素。结果 单因素分析显示， 与非POD组相比， POD组患者饮酒、 有脑血管病史的比例升高， 术后早期电解质紊乱和低氧血症的比例升高， 粒细胞/淋巴细胞、 停循环时间和术中用血量均明显升高， 发病至手术时间短， 但纤维蛋白原水平下降 （均 P＜0.05）。多因素Logistic回归分析显示， 术中用血量增多 （OR=1.733， 95%CI： 1.409~2.129）、 术后早期电解质紊乱（OR=10.500， 95%CI： 2.930~37.622） 是StanfordA型主动脉夹层患者发生POD的独立危险因素， 而术前纤维蛋白原水平较高 （OR=0.157， 95%CI： 0.050~0.635）、 发病至手术时间延长 （OR=0.871， 95%CI： 0.808~0.943） 则是保护因素。结论 早期识别POD的危险因素， 积极干预对减少POD的发生具有积极的意义。

Analysis of the related risk factors of postoperative delirium in patients with Stanford type A aortic dissection

Abstract: Objective To analyze the related risk factors of postoperative delirium (POD) in patients with Stanford type A aortic dissection, and to guide clinical practices. Methods The clinical data of 118 cases [81 males and 37 females, average age (55.0 ± 10.3) years] with Stanford type A aortic dissection in Tianjin Chest Hospital from January 2016 to December 2017 were analysed in this study. According to whether developed delirium after surgery, the patients were divided into POD group (n=56) and Non-POD group (n=62). The preoperative, perioperative, and postoperative clinical data were collected. The univariate and multivariate Logistic regression analysis was used to investigate the risk factors of POD in patients with the Stanford type A aortic dissection. Results Single factor analysis showed that the proportions of drinking and cerebrovascular history significantly increased, the proportions of early electrolyte disorder and hypoxemia significantly increased, the levels of granulocytes / lymphocytes, circulatory time and blood volume during operation increased significantly, and the duration from onset to operation was decreased, but fibrinogen level decreased significantly in POD group than those of Non-POD group (P < 0.05). Multivariate Logistic analysis indicated that the more intraoperative consumption of blood (OR=1.733, 95%CI： 1.409-2.129) and early postoperative electrolyte disorder (OR=10.500, 95%CI： 2.930-37.622) were independent risk factors of POD, while the higher level of preoperative fibrinogen (OR=0.157, 95%CI： 0.050-0.635) and longer time from onset to surgery (OR=0.871, 95%CI： 0.808-0.943) were protective factors of POD in patients with Stanford type A aortic dissection. Conclusion The early identification of risk factors of POD, and the active intervention of POD have a positive significance to reduce the occurrence of POD.