收稿日期: 2021-08-20
网络出版日期: 2022-01-28
基金资助
上海交通大学医学院护理学科建设项目
Relationship between preoperative glycosylated hemoglobin and postoperative delirium in patients following off-pump coronary artery bypass grafting
Received date: 2021-08-20
Online published: 2022-01-28
Supported by
Shanghai Jiao Tong University School of Medicine：Nursing Development Program
目的·研究非体外循环冠状动脉搭桥（off-pump coronary artery bypass surgery，OPCAB）患者术前糖化血红蛋白（hemoglobin A1c，HbA1c）水平与术后谵妄的关系，为进一步实施干预提供参考依据。方法·采用前瞻性研究，纳入上海交通大学医学院附属瑞金医院心脏外科收治的OPCAB手术患者364例，通过一般资料问卷、简易智力状态评估量表收集资料，通过ICU意识模糊评估量表、中文版3D-CAM谵妄量表评估术后谵妄。采用单因素分析，筛选出P<0.05的谵妄的危险因素后，再进行多因素Logistic回归分析。利用广义相加模型观察HbA1c水平与术后谵妄发生率的动态变化，并绘制受试者操作特征曲线（receiver operating characteristic curve，ROC curve），明确其界值。结果·OPCAB患者术后谵妄的影响因素有年龄、饮酒史、糖尿病、贫血、周围血管疾病、术前心功能分级、左室射血分数、白蛋白、HbA1c、术中输血、酸碱失衡、电解质紊乱。通过广义相加模型和多因素Logistic回归分析，结果显示术前HbA1c值越高，OPCAB患者术后谵妄的发生率越高。通过ROC曲线分析，确定当HbA1c值>6.45%时，OPCAB术后谵妄发生的风险随之增高。结论·对于接受OPCAB手术的患者，HbA1c值是术后谵妄的独立危险因素；随着HbA1c值的升高，谵妄的发生率也逐渐增高。提示OPCAB患者术前HbA1c值应尽量维持在正常水平。
关键词： 非体外循环冠状动脉搭桥; 术后谵妄; 影响因素; 糖化血红蛋白; 受试者操作特征曲线
何烨 , 方芳 . 非体外循环冠状动脉搭桥患者术前糖化血红蛋白水平与术后谵妄的关系[J]. 上海交通大学学报（医学版）, 2022 , 42(1) : 21 -27 . DOI: 10.3969/j.issn.1674-8115.2022.01.004
·To investigate the relationship between postoperative delirium and preoperative HbA1c in patients with off-pump coronary artery bypass grafting (OPCAB), so as to provide reference for further intervention.
·A prospective study was used to collect 364 surgical patients admitted to the Department of Cardiac Surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The data were collected through the general information questionnaire and the simple mental status assessment scale, and the Confusion Assessment Method of Intensive Care Unit, and Chinese Version of 3-minute Diagnostic Confusion Assessment Method were used to assess postoperative delirium. Univariate analysis was used to screen out the risk factors for delirium with P<0.05, and then a multi-factor Logistic regression analysis was used. The generalized additive model was used to observe the dynamic changes of HbA1c and the incidence of postoperative delirium, and the receiver operating characteristic (ROC) curve was drawn to clarify the boundary value.
·The influencing factors of postoperative delirium in OPCAB patients were age, alcohol use, peripheral vascular disease, NYHA function classification, LVEF, albumin, HbA1c, intraoperative blood transfusion, acid-base imbalance, and electrolyte imbalance. The generalized additive model and multivariate Logistic regression analysis showed that the higher the preoperative HbA1c, the higher the incidence of postoperative delirium in OPCAB patients.Through ROC curve analysis, it was determined that when the HbA1c>6.45%, the risk of delirium after OPCAB increased accordingly.
·For patients undergoing OPCAB surgery, HbA1c is an independent risk factor for postoperative delirium. With the increase of HbA1c, the incidence of delirium gradually increases, suggesting that the preoperative HbA1c of OPCAB patients should be maintained at a normal level.
| 1 | 陈红, 汪慧娟, 陈瑜. 术后谵妄病人非药物管理最佳证据综合[J]. 护理研究, 2019, 33(23): 4108-4112. |
| 2 | OLIN K, ERIKSDOTTER-JONHAGEN M, JANSSON A, et al. Postoperative delirium in elderly patients after major abdominal surgery[J]. Br J Surg, 2005, 92(12): 1559-1564. |
| 3 | MARISCALCO G, COTTINI M, ZANOBINI M, et al. Preoperative statin therapy is not associated with a decrease in the incidence of delirium after cardiac operations[J]. Ann Thorac Surg, 2012, 93(5): 1439-1447. |
| 4 | CEREGHETTI C, SIEGEMUND M, SCHAEDELIN S, et al. Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: an observational cohort study[J]. J Cardiothorac Vasc Anesth, 2017, 31(6): 1966-1973. |
| 5 | BROWN C H, PROBERT J, HEALY R, et al. Cognitive decline after delirium in patients undergoing cardiac surgery[J]. Anesthesiology, 2018, 129(3): 406-416. |
| 6 | SMULTER N, LINGEHALL H C, GUSTAFSON Y, et al. Delirium after cardiac surgery: incidence and risk factors[J]. Interact Cardiovasc Thorac Surg, 2013, 17(5): 790-796. |
| 7 | NEUFELD K J, LEOUTSAKOS J M, SIEBER F E, et al. Outcomes of early delirium diagnosis after general anesthesia in the elderly[J]. Anesth Analg, 2013, 117(2): 471-478. |
| 8 | INOuYE S K, MARCANTONIO E R, KOSAR C M, et al. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients[J]. Alzheimers Dement, 2016, 12(7): 766-775. |
| 9 | SACZYNSKI J S, MARCANTONIO E R, QUACH L, et al. Cognitive trajectories after postoperative delirium[J]. N Engl J Med, 2012, 367(1): 30-39. |
| 10 | 车智美, 虞敏. 心脏外科术后谵妄的研究进展[J]. 上海交通大学学报(医学版), 2016, 36(11): 1661-1663. |
| 11 | 彭晓红, 丁雪茹, 董正惠. 心脏外科重症监护病房ICU谵妄发生状况及影响因素分析[J]. 解放军预防医学杂志, 2019, 37(6): 182-183. |
| 12 | KOTFIS K, SZYLINSKA A, LISTEWNIK M, et al. Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study[J]. Neuropsychiatr Dis Treat, 2019, 15: 511-521. |
| 13 | 吴明隆. 问卷统计分析实务:SPSS操作与应用[M]. 重庆: 重庆大学出版社, 2010. |
| 14 | SEITZ D P, CHAN C C, NEWTON H T, et al. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting[J]. Cochrane Database Syst Rev, 2018, 2: CD011415. |
| 15 | ELY E W, INOUYE S K, BERNARD GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710. |
| 16 | 高浪丽, 谢冬梅, 董碧蓉, 等. 中文版3D-CAM谵妄量表在老年患者中使用的信度和效度研究[J]. 中华老年医学杂志, 2018, 37(10):1073-1077. |
| 17 | KOTFIS K, ?LOZOWSKA J, SAFRANOW K, et al. The practical use of white cell inflammatory biomarkers in prediction of postoperative delirium after cardiac surgery[J]. Brain Sci, 2019, 9(11): 308. |
| 18 | SHAW P, SALEEM T, GAHTAN V. Correlation of hemoglobin A1C level with surgical outcomes: can tight perioperative glucose control reduce infection and cardiac events?[J]. Semin Vasc Surg, 2014, 27(3/4): 156-161. |
| 19 | 闫晓英, 刘哲, 宋艳, 等. A型主动脉夹层术患者术后谵妄的影响因素分析[J]. 护理实践与研究, 2020, 17(1): 7-10. |
| 20 | 王静. 老年消化系统肿瘤患者术后谵妄影响因素的病例对照研究[J]. 护理学报, 2017, 24(1): 61-65. |
| 21 | 郑晓梅, 崔丹.非体外冠状动脉旁路移植术后谵妄的影响因素分析[J].医学临床研究, 2018, 35(7): 1433-1435. |
| 22 | KOTFIS K, SZYLINSKA A, LISTEWNIK M, et al. Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients[J]. Clin Interv Aging, 2018, 13: 1061-1070. |
| 23 | 李晓晴, 马闻建, 姜霁纹, 等.冠状动脉旁路移植术后谵妄的发生率和相关危险因素研究[J].中华神经科杂志, 2015, 48(12): 1069-1073. |
| 24 | NIKOLIC B D, PUTNIK S M, LAZOVIC D M, et al. Can we identify risk factors for postoperative delirium in cardiac coronary patients? our experience[J]. Heart Surg Forum, 2012, 15(4): 195. |
| 25 | 国欣涛, 魏荣伟, 王斌. 冠状动脉搭桥术后谵妄的研究现状[J]. 医学信息, 2019, 32(10): 53-56. |
| 26 | CAI S, LATOUR J M, LIN Y, et al. Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: a prospective cohort study[J]. Eur J Cardiovasc Nurs, 2020, 19(4): 310-319. |
| 27 | 邢焕民, 吕冬梅, 王晓慧, 等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志, 2019, 54(1): 8-13. |
| 28 | ZHANG W Y, WU W L, GU J J, et al. Risk factors for postoperative delirium in patients after coronary artery bypass grafting: a prospective cohort study[J]. J Crit Care, 2015, 30(3): 606-612. |
| 29 | 许晨, 张艺雄. 心脏外科术后谵妄影响因素的研究进展[J]. 全科护理, 2018, 16(34): 4247-4250. |
/
| 〈 |
|
〉 |