Analysis Of Risk Factors Of Delirium After Heart Valve Replacement In Adults And Construction Of Risk Assessment System

ObjectiveThis paper aims to assess the incidence of delirium in patients after cardiac valve replacement;to investigate risk factors of delirium after cardiac valve replacement;to make a construction of risk assessment system for delirium after cardiac valve replacement so that the establishment and integrity of risk assessment tool can be provided with a better framework.The risk assessment system can also offer clinical nurses scientific guidance and basis to early detect the delirium after cardiac valve replacement so as to promote the recovery of patients.Methods The study is divided into two parts.The first part:Building a research group for the delirium after cardiac valve replacement.Then,based on literature review,clinical nursing practice and the brainstorming of research group,the risk factors that affect the delirium after cardiac valve replacement can be preliminarily evaluated.Meanwhile,a questionnaire for risk factors of delirium after cardiac valve replacement was also designed.In this study,patients who met the inclusion criteria after cardiac valve replacement in the cardiac surgery ICU of a third-grade hospital in Qingdao from August 2018 to June 2019 were selected as research subjects.By using the self-designed questionnaire for risk factors of delirium after cardiac valve replacement,the specific data of research subjects can be collected.at the same time,the CAM-ICU was applied to screen the patients with postoperative delirium.Firstly,single factor analysis was used to screen out factors that may be related to the delirium in patients after cardiac valve replacement.Secondly,Logistic regression analysis was used to screen out the independent risk factor for postoperative delirium in patients,with postoperative delirium as the dependent variable and factors that might affect postoperative delirium as the independent variable.The second part:Combined with the research results in the first part,the study used the semi-structured interview to systemulate a questionnaire for the risk assessment index system of postoperative delirium in patients with cardiac valve replacement.The Delphi method was used to conduct two rounds of consultation with 21 nursing experts in five domestic Grade-A Tertiary Hospital to determine the risk assessment indicators of postoperative delirium in patients by heart valve replacement.The importance of experts was assigned to calculate the index weight,and the evaluation index system of postoperative delirium risk in patients with cardiac valve replacement was constructed.Results1 A total of 212 patients with cardiac valve replacement were collected in this investigation,of which 43 cases of postoperative delirium occurred,and the incidence of postoperative delirium was 20.28%.Logistic regression analysis showed that postoperative delirium in patients with heart valve replacement is related to Age(P?0.001),Preoperative cardiac insufficiency(P=0.02),Time of CPB(P?0.001),Simultaneous coronary artery bypass(P=0.002),Intraoperative blood lost(P=0.003),Excessive pain(P=0.024)and Residence time in CSICU(P=0.044).As a result,Age,Preoperative cardiac insufficiency,Time of CPB,Simultaneous coronary artery bypass,Intraoperative blood lost,Excessive pain and Residence time in CSICU are high risk factors for postoperative delirium.1.The results of Delphi method: 21 experts were surveyed in the first round of expert consultation.The positive coefficient of the experts was 100%.The authoritative coefficient was 0.86,and the coordination coefficient was 0.21.There were also 21 experts in the second round of inquiry survey.The positive coefficient of the experts was 100%.The authoritative coefficient was 0.86,and the coordination coefficient was 0.30.After 2 rounds of expert consultation,the evaluation system of delirium risk after cardiac valve replacement in adults was established,including 3 first-grade indicators and 20 second-grade indicators.Conclusion 1.The incidence of delirium after cardiac valve replacement in adults is relatively high(incidence rate: 20.28%)and it needs clinical attention.2.The independent risks of delirium after cardiac valve replacement in adults are Age,Preoperative cardiac insufficiency,Time of CPB,Simultaneous coronary artery bypass,Intraoperative blood lost,Excessive pain and Residence time in CSICU.3.The evaluation indicator system of delirium risks after cardiac valve replacement in adults contains 3 first-grade indicators and 20 second-grade indicators.The three first-grade indicators include individual risk indicators,disease risk indicators and.iatrogenic risk indicators.