Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: a prospective cohort study
Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: a prospective cohort study
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DOI：
10.1177/1474515119886155
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发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
Zhang, Yuxia
中科院分区：
文献类型：
--
作者：
Cai, Shining;Latour, Jos M.;Zhang, Yuxia
背景：谵妄是心脏手术后常见的并发症。谵妄与心功能之间的关系尚未完全阐明。目的：本研究的目的是确定心脏手术后患者术前心功能与谵妄之间的关系。方法：我们前瞻性地招募635例计划入住心脏重症监护病房的心脏手术患者。重症监护室术后谵妄诊断采用神志不清评定法。术前采用脑利钠肽n端原激素（NT-proBNP）、纽约心脏协会功能分级和左室射血分数评估心功能。结果：73例患者（11.5%）在重症监护病房期间出现谵妄。校正各种混杂因素后，NT-proBNP水平（优势比（OR） 1.24, 95%可信区间（CI） 1.01-1.52）和纽约心脏协会功能分类（OR 2.34, 95% CI 1.27-4.31）均与谵妄的发生独立相关。在拐点为7.8（对数转换pg/ml）后，谵妄OR随NT-proBNP水平的升高而升高。NT-proBNP小于7.8 （log-transformed pg/ml）的校正回归系数为1.19 (95% CI 0.95-1.49， P=0.134)， NT-proBNP大于7.8 （log-transformed pg/ml）的校正回归系数为2.78 （95% CI 1.09-7.12， P=0.033）。左心室射血分数与术后谵妄无相关性。结论：术前心功能参数NT-proBNP和纽约心脏协会功能分级可预测心脏手术后谵妄的发生。我们建议合并术前心功能的早期测定，作为心脏手术前谵妄的风险评估。
Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27-4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95-1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09-7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.