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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (05) : 386 -392. doi: 10.3877/cma.j.issn.1674-6880.2021.05.007

论著

儿童术后谵妄发生现况及危险因素分析
林楠1, 刘柯显1, 冯静怡2, 陈阮3, 应燕3, 吕丹尼4, 周悦3, 徐红贞1,()   
  1. 1. 310052 杭州,浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心护理部
    2. 310052 杭州,浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心耳鼻喉头颈外科
    3. 310052 杭州,浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心普外科
    4. 310052 杭州,浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心肿瘤外科
  • 收稿日期:2021-03-22 出版日期:2021-10-31
  • 通信作者: 徐红贞
  • 基金资助:
    2021年浙江省卫生健康面上项目(2021KY187)

Current conditions and risk factors for postoperative delirium in pediatric patients

Nan Lin1, Kexian Liu1, Jingyi Feng2, Ruan Chen3, Yan Ying3, Danni Lyu4, Yue Zhou3, Hongzhen Xu1,()   

  1. 1. Department of Nursing, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
    2. Department of Otorhinolaryngology Head and Neck Surgery, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
    3. Department of General Surgery, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
    4. Department of Surgical Oncology, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
  • Received:2021-03-22 Published:2021-10-31
  • Corresponding author: Hongzhen Xu
引用本文:

林楠, 刘柯显, 冯静怡, 陈阮, 应燕, 吕丹尼, 周悦, 徐红贞. 儿童术后谵妄发生现况及危险因素分析[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(05): 386-392.

Nan Lin, Kexian Liu, Jingyi Feng, Ruan Chen, Yan Ying, Danni Lyu, Yue Zhou, Hongzhen Xu. Current conditions and risk factors for postoperative delirium in pediatric patients[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(05): 386-392.

目的

探讨儿童术后谵妄的发生现况,并分析相关危险因素。

方法

采用前瞻性队列研究设计,收集浙江大学医学院附属儿童医院2020年2月至6月收治的1 134例行择期手术患儿的临床资料。采用多因素Logistic回归模型分析患儿术后谵妄发生的危险因素,并采用Hosmer-Lemeshow检验分析模型的校准度。

结果

根据患儿是否发生术后谵妄,将1 134例患儿分为谵妄组(126例)和非谵妄组(1 008例),谵妄发生率为11.11%(126/1 134),发生时间集中于术后40.0(35.0,50.0)min,持续时间为10.0(5.0,15.0)min。谵妄组患儿的住院时间较非谵妄组显著增加[11.0(7.0,16.0)d vs. 4.0(3.0,7.0)d,Z = 13.791,P < 0.001]。谵妄组和非谵妄组患儿年龄(χ2 = 75.129,P < 0.001)、发育迟缓(χ2 = 14.995,P < 0.001)、存在既往疾病(χ2 = 7.434,P = 0.006)、手术类型(χ2 = 18.903,P < 0.001)、禁食时长(Z = 3.048,P = 0.002)、麻醉时长(Z = 2.056,P = 0.040)、疼痛程度(χ2 = 347.649,P < 0.001)、右美托咪定(χ2 = 4.904,P = 0.027)比较,差异均有统计学意义。将其纳入多因素Logistic回归分析,结果显示,年龄、发育迟缓、手术类型、疼痛程度、右美托咪定是患儿术后发生谵妄的危险因素(P均< 0.05)。Hosmer-Lemeshow检验结果表明该模型具有较好的拟合效果(χ2 = 12.833,P = 0.118)。

结论

儿童术后存在一定的谵妄风险,年龄≤ 5岁、发育迟缓、耳鼻喉头颈外科手术、中重度疼痛、应用右美托咪定的患儿易发生术后谵妄。

Objective

To determine the occurrence of postoperative delirium in pediatric patients and explore associated risk factors.

Methods

A prospective cohort study was designed to collect clinical data of 1 134 children with routine elective surgery admitted to the Children's Hospital, Zhejiang University School of Medicine from February to June 2020. A multivariate Logistic regression model was used to analyze the risk factors for postoperative delirium in children, and the Hosmer-Lemeshow test was used to analyze the model calibration.

Results

Based on the occurrence of postoperative delirium, 1 134 children were divided into a delirium group (n = 126) and a non-delirium group (n = 1 008). The incidence of delirium was 11.11% (126/1 134), with the onset concentrated at 40.0 (35.0, 50.0) min after surgery and the duration of 10.0 (5.0, 15.0) min. The hospitalization time in the delirium group significantly increased compared with the non-delirium group [11.0 (7.0, 16.0) d vs. 4.0 (3.0, 7.0) d, Z = 13.791, P < 0.001]. The age (χ2 = 75.129, P < 0.001), developmental delay (χ2 = 14.995, P < 0.001), previous disease (χ2 = 7.434, P = 0.006), type of surgery (χ2 = 18.903, P < 0.001), fasting duration (Z = 3.048, P = 0.002), anesthesia duration (Z = 2.056, P = 0.040), pain degree (χ2 = 347.649, P < 0.001) and dexmedetomidine (χ2 = 4.904, P = 0.027) were statistically significantly different between the delirium group and non-delirium group. The multivariate Logistic regression analysis revealed that the age, developmental delay, type of surgery, pain degree and dexmedetomidine were risk factor of postoperative delirium in children (all P < 0.05). The Hosmer-Lemeshow test showed that the model had a good fitting effect (χ2 = 12.833, P = 0.118).

Conclusion

Children are at risk for delirium after surgery, and those with age ≤ 5 years, developmental delay, otorhinolaryngology head and neck surgery, moderate to severe pain and dexmedetomidine are prone to postoperative delirium.

表1 两组行择期手术的患儿术后发生谵妄的单因素分析[例(%)]
组别 例数 年龄 性别 发育迟缓 存在既往疾病
0~2岁 3~5岁 6 ~ 16岁
谵妄组 126 76(60.32) 42(33.33) 8(6.35) 83(65.87) 43(34.13) 13(10.32) 1(0.79)
非谵妄组 1 008 292(28.97) 274(27.18) 442(43.85) 593(58.83) 415(41.17) 32(3.17) 79(7.84)
χ2/Z   75.129 2.308 14.995 7.434
P   < 0.001 0.129 < 0.001 0.006
组别 例数 ASA分级 手术类型 夜间睡眠时长[h,MP25P75)]
Ⅰ级 Ⅱ级 耳鼻喉头颈外科手术 胸腹部手术 骨科手术 其他手术
谵妄组 126 98(77.78) 28(22.22) 59(46.83) 21(16.67) 25(19.84) 21(16.67) 8.58(8.00,9.50)
非谵妄组 1 008 828(82.14) 180(17.86) 304(30.16) 284(28.17) 284(28.17) 136(13.49) 8.75(8.00,9.50)
χ2/Z   1.425 18.903 0.403
P   0.233 < 0.001 0.687
组别 例数 禁食时长[h,MP25P75)] 麻醉时长[min,MP25P75)] 手术时长[min,MP25P75)] 术中出血量[mL,MP25P75)] 疼痛程度
无痛或轻度疼痛 中度疼痛 重度疼痛
谵妄组 126 11.31(8.96,13.12) 52.00(40.00,81.00) 28.00(18.75,56.00) 1.00(1.00,5.00) 43(34.13) 45(35.71) 38(30.16)
非谵妄组 1 008 12.21(9.00,15.00) 58.00(45.00,78.00) 30.00(20.00,50.00) 2.00(1.00,5.00) 937(92.96) 53(5.26) 18(1.79)
χ2/Z   3.048 2.056 1.609 1.430 347.649
P   0.002 0.040 0.108 0.153 < 0.001
组别 例数 用药情况
丙泊酚 苯二氮类药物 皮质类固醇类药物 抗胆碱能药物 右美托咪定 阿片类受体激动剂 神经肌肉阻滞剂
谵妄组 126 123(97.62) 108(85.71) 76(60.32) 74(58.73) 85(67.46) 75(59.52) 67(53.17)
非谵妄组 1 008 976(96.83) 867(86.01) 603(59.82) 500(49.60) 576(57.14) 583(57.84) 513(50.89)
χ2/Z   0.045 0.008 0.011 3.732 4.904 0.131 0.233
P   0.832 0.928 0.915 0.053 0.027 0.718 0.629
表2 行择期手术患儿术后发生谵妄的多因素Logistic回归分析
图1 行择期手术患儿术后谵妄风险预测模型校准图
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