胸外科手术患者发生术中低血压与术后谵妄的关系:一项回顾性队列研究
The association between intraoperative hypotension and postoperative delirium in thoracic surgery patients:a retrospective cohort study
谭芮茜 1李华凤 2左一丁 1周萌萌 3吴雅莉 3杨静3
作者信息
- 1. 四川大学华西医院麻醉手术中心,四川成都 610000;四川大学华西厦门医院麻醉手术中心,福建厦门 361000
- 2. 四川大学华西第二医院麻醉手术中心,四川成都 610000
- 3. 四川大学华西医院麻醉手术中心,四川成都 610000
- 折叠
摘要
目的 探讨术中低血压定义为平均动脉压小于60 mmHg时与术后谵妄的相关性,为临床提供参考.方法 本研究为一项回顾性队列研究,纳入2020年12月至2021年11月于四川大学华西医院接受胸外科手术患者508例.收集患者数据资料包括:一般情况、术前睡眠评分、术前认知功能、手术相关资料、集束化干预策略、术后去向、是否术后谵妄、术中血压数据等.采用二元Logistic回归、多元Logistic回归、亚组分析等进行统计分析.结果 本研究发现术中低血压不直接影响术后谵妄发生率.亚组分析结果显示,出现过术中低血压的术后谵妄患者更倾向于表现为抑郁型谵妄.吸烟者和未采取集束化干预策略者发生术中低血压后更易术后谵妄.患者高龄、术前睡眠差及开胸手术是发生术后谵妄的独立危险因素.结论 患者术中低血压与术后谵妄的发生无直接关联,但当患者存在其他谵妄危险因素时,术中低血压的影响可能会被放大.对术中平均动脉压至少有1次＜60 mmHg的患者,术后应更多地关注患者认知功能,以及时识别临床表现不明显的抑郁型谵妄.
Abstract
Objective To explore the correlation between intraoperative hypotension defined as mean arterial pres-sure less than 60 mmHg and postoperative delirium,to provide clinical reference.Methods This study was a retrospec-tive cohort study.A total of 508 patients who underwent thoracic surgery in West China Hospital of Sichuan University from December 2020 to November 2021 were included.The data of patients included:general condition,preoperative sleep score,preoperative cognitive function,surgery-related data,cluster intervention strategy,postoperative destina-tion,postoperative delirium,intraoperative blood pressure data,etc.Binary Logistic regression,multiple Logistic regres-sion and subgroup analysis were used for statistical analysis.Results This study found that intraoperative hypotension did not directly affect the incidence of postoperative delirium.Subgroup analysis showed that postoperative delirium pa-tients with intraoperative hypotension were more likely to present with depressive delirium.Smokers and patients with-out cluster intervention strategies are more likely to have postoperative delirium after intraoperative hypotension.Ad-vanced age,poor preoperative sleep and thoracotomy are independent risk factors for postoperative delirium.Conclusion There is no direct correlation between intraoperative hypotension and postoperative delirium,but the effect of intrao-perative hypotension may be amplified when the patient has other risk factors for delirium.For patients with mean arte-rial pressure＜60 mmHg at least once during operation,more attention should be paid to the cognitive function of pa-tients after operation,and the depressive delirium without obvious clinical manifestations should be identified in time.
关键词
术后谵妄/术中低血压/麻醉管理/麻醉监测/平均动脉压Key words
postoperative delirium/intraoperative hypotension/anesthesia management/anesthesia monitoring/mean arterial pressure引用本文复制引用
基金项目
四川大学华西医院优秀学科1·3·5临床科研孵化项目(2021HXFH039)
出版年
2024
NETL
NSTL
万方数据