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Abstract：
BACKGROUND: The aim of this study was to identify the risk factors for postoperative delirium (POD) in elderly patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).
METHODS: Elderly patients undergoing elective heart valve surgery with CPB in The First Affiliated Hospital of Wenzhou Medical University between March 2022 and March 2023 were selected for this investigation. They were divided into a POD group and a non-POD group. Their baseline information was collected and recorded, and the patients were subjected to neurocognitive function assessment using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales before surgery. We also recorded their intraoperative indicators such as duration of surgery, duration of CPB, duration of aortic cross-clamp, blood transfusion, and postoperative indicators such as duration of mechanical ventilation, postoperative 24-hour drainage volume, and pain score. Regional cerebral oxygen saturation was monitored intraoperatively by near-infrared spectroscopy based INVOS5100C Regional Oximeter. Patients were assessed for the occurrence of POD using Confusion Assessment Method for the Intensive Care Unit, and logistic regression analysis of risk factors for POD was performed.
RESULTS: The study finally included 132 patients, with 47 patients in the POD group and 85 ones in the non-POD group. There were no significant differences in baseline information and preoperative indicators between the two groups. However, marked differences were identified in duration of surgery, duration of CPB, duration of aortic cross-clamp, duration of postoperative mechanical ventilation, postoperative length of stay in cardiac intensive care unit, postoperative length of hospital stay, intraoperative blood transfusion, postoperative pain score, and postoperative 24-hour drainage volume between the two groups (p < 0.05). Additionally, the two groups had significant differences in rScO2 at each intraoperative time point and in the difference of rScO2 from baseline at each intraoperative time point (p < 0.05). Multivariate logistic regression analysis showed that duration of surgery > 285 min (OR, 1.021 [95% CI, 1.008-1.035]; p = 0.002), duration of postoperative mechanical ventilation > 23.5 h (OR, 6.210 [95% CI, 1.619-23.815]; p = 0.008), and postoperative CCU stay > 3.5 d (OR, 3.927 [95% CI, 1.046-14.735]; p = 0.043) were independent risk factors of the occurrence of POD while change of rScO2 at T1>50.5 (OR, 0.832 [95% CI 0.736-0.941]; p = 0.003) was a protective factor for POD.
CONCLUSIONS: Duration of surgery duration of postoperative mechanical ventilation and postoperative CCU stay are risk factors for POD while change of rScO2 at T1 is a protective factor for POD in elderly patients undergoing heart valve surgery with CPB.
METHODS: Elderly patients undergoing elective heart valve surgery with CPB in The First Affiliated Hospital of Wenzhou Medical University between March 2022 and March 2023 were selected for this investigation. They were divided into a POD group and a non-POD group. Their baseline information was collected and recorded, and the patients were subjected to neurocognitive function assessment using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales before surgery. We also recorded their intraoperative indicators such as duration of surgery, duration of CPB, duration of aortic cross-clamp, blood transfusion, and postoperative indicators such as duration of mechanical ventilation, postoperative 24-hour drainage volume, and pain score. Regional cerebral oxygen saturation was monitored intraoperatively by near-infrared spectroscopy based INVOS5100C Regional Oximeter. Patients were assessed for the occurrence of POD using Confusion Assessment Method for the Intensive Care Unit, and logistic regression analysis of risk factors for POD was performed.
RESULTS: The study finally included 132 patients, with 47 patients in the POD group and 85 ones in the non-POD group. There were no significant differences in baseline information and preoperative indicators between the two groups. However, marked differences were identified in duration of surgery, duration of CPB, duration of aortic cross-clamp, duration of postoperative mechanical ventilation, postoperative length of stay in cardiac intensive care unit, postoperative length of hospital stay, intraoperative blood transfusion, postoperative pain score, and postoperative 24-hour drainage volume between the two groups (p < 0.05). Additionally, the two groups had significant differences in rScO2 at each intraoperative time point and in the difference of rScO2 from baseline at each intraoperative time point (p < 0.05). Multivariate logistic regression analysis showed that duration of surgery > 285 min (OR, 1.021 [95% CI, 1.008-1.035]; p = 0.002), duration of postoperative mechanical ventilation > 23.5 h (OR, 6.210 [95% CI, 1.619-23.815]; p = 0.008), and postoperative CCU stay > 3.5 d (OR, 3.927 [95% CI, 1.046-14.735]; p = 0.043) were independent risk factors of the occurrence of POD while change of rScO2 at T1>50.5 (OR, 0.832 [95% CI 0.736-0.941]; p = 0.003) was a protective factor for POD.
CONCLUSIONS: Duration of surgery duration of postoperative mechanical ventilation and postoperative CCU stay are risk factors for POD while change of rScO2 at T1 is a protective factor for POD in elderly patients undergoing heart valve surgery with CPB.
摘要：
背景：本研究的目的是确定体外循环（CPB）心脏瓣膜手术老年患者术后谵妄（POD）的危险因素。
方法：选取2022年3月至2023年3月在温州医科大学附属第一医院择期行CPB心脏瓣膜手术的老年患者为研究对象。他们分为POD组和非POD组。收集并记录他们的基线信息，术前采用简易精神状态检查量表和蒙特利尔认知评估量表对患者进行神经认知功能评估。我们还记录了他们的术中指标，如手术持续时间，CPB的持续时间，主动脉交叉钳夹的持续时间，输血,和术后指标，如机械通气的持续时间，术后24小时引流量,和疼痛评分。术中通过基于INVOS5100C区域血氧仪的近红外光谱监测区域脑氧饱和度。使用重症监护病房的混淆评估方法评估患者POD的发生，并对POD的危险因素进行logistic回归分析。
结果：该研究最终包括132名患者，POD组47例，非POD组85例。两组患者的基线资料和术前指标差异无统计学意义。然而,在手术持续时间上发现了明显的差异，CPB的持续时间，主动脉交叉钳夹的持续时间，术后机械通气的持续时间，术后在心脏重症监护室的住院时间,术后住院时间,术中输血,术后疼痛评分,术后24小时引流量两组比较(p<0.05)。此外,两组术中各时间点的rScO2和术中各时间点的rScO2与基线的差异均有统计学意义(p<0.05).多因素logistic回归分析显示手术时间>285min(OR,1.021[95%CI，1.008-1.035]；p=0.002)，术后机械通气持续时间>23.5h(OR，6.210[95%CI，1.619-23.815]；p=0.008)，术后CCU停留时间>3.5d(OR，3.927[95%CI,1.046-14.735];p=0.043)是POD发生的独立危险因素,而rScO2在T1>50.5时的变化(OR,0.832[95%CI0.736-0.941]；p=0.003)是POD的保护因素。
结论：老年CPB心脏瓣膜手术患者术后机械通气持续时间和术后CCU停留时间是POD的危险因素，而T1时rScO2的变化是POD的保护因素。
方法：选取2022年3月至2023年3月在温州医科大学附属第一医院择期行CPB心脏瓣膜手术的老年患者为研究对象。他们分为POD组和非POD组。收集并记录他们的基线信息，术前采用简易精神状态检查量表和蒙特利尔认知评估量表对患者进行神经认知功能评估。我们还记录了他们的术中指标，如手术持续时间，CPB的持续时间，主动脉交叉钳夹的持续时间，输血,和术后指标，如机械通气的持续时间，术后24小时引流量,和疼痛评分。术中通过基于INVOS5100C区域血氧仪的近红外光谱监测区域脑氧饱和度。使用重症监护病房的混淆评估方法评估患者POD的发生，并对POD的危险因素进行logistic回归分析。
结果：该研究最终包括132名患者，POD组47例，非POD组85例。两组患者的基线资料和术前指标差异无统计学意义。然而,在手术持续时间上发现了明显的差异，CPB的持续时间，主动脉交叉钳夹的持续时间，术后机械通气的持续时间，术后在心脏重症监护室的住院时间,术后住院时间,术中输血,术后疼痛评分,术后24小时引流量两组比较(p<0.05)。此外,两组术中各时间点的rScO2和术中各时间点的rScO2与基线的差异均有统计学意义(p<0.05).多因素logistic回归分析显示手术时间>285min(OR,1.021[95%CI，1.008-1.035]；p=0.002)，术后机械通气持续时间>23.5h(OR，6.210[95%CI，1.619-23.815]；p=0.008)，术后CCU停留时间>3.5d(OR，3.927[95%CI,1.046-14.735];p=0.043)是POD发生的独立危险因素,而rScO2在T1>50.5时的变化(OR,0.832[95%CI0.736-0.941]；p=0.003)是POD的保护因素。
结论：老年CPB心脏瓣膜手术患者术后机械通气持续时间和术后CCU停留时间是POD的危险因素，而T1时rScO2的变化是POD的保护因素。
