Analysis On The Risk Factors Of Early Postoperative Delirium Under Aortic Arch Surgery

Background: Aortic dissection(AD)is a very dangerous cardiovascular emergency.Aortic aneurysms,especially those involving the arch,are also at high risk.For such diseases,the best method is prompt surgical intervention.These operations need to be performed under hypothermic circulation arrest,and postoperative complications,especially neurological complications occur frequently.Delirium as one of the neurological complications is easily ignored by medical workers.The occurrence of delirium can lead to longer ICU hours,increased medical costs,and increased postoperative mortality.Therefore,we need to screen for high-risk patients and diagnose delirium as early as possible in order to provide corresponding interventional measures before,during,and after operation,and then we can prevent the occurrence of delirium,reduce the length of time of delirium and improve prognosis of delirium.Objective: Analyze the incidence and severity of early postoperative delirium in patients with aortic dissection or aneurysm under hypothermic circulation arrest,explore the possible risk factors;Compare the effect of different risk factors on the severity of early postoperative delirium in patients with aortic dissection or aneurysm,aim at helping prevent the occurrence of delirium,reduce the severity of delirium,shorten the duration of delirium in clinical practice.Methods: Altogether for 101 patients who were diagnosed with aortic dissection or aneurysm and then underwent aortic arch surgery under hypothermic circulation arrest of the First Affiliated Hospital of China Medical University from November 1,2019 to December 31,2020 were selected as study subjects.To explore possible risk factors for early postoperative delirium,and to explore whether the influencing factors for early postoperative delirium in patients with aortic dissection aneurysm are related to the highest ICDSC scores.The confusion assessment method-ICU(CAM-ICU)and the intensive care delirium screen checklist(ICDSC)were used to identify whether delirium occurs and to evaluate the severity of delirium in the early postoperative period.Results: Of the 101 patients enrolled,delirium occurred in 29 cases,with a total delirium incidence of 28.7%.Single factor analysis showed that early postoperative delirium group and non-delirium group were statistically significant(P < 0.05)in preoperative anticoagulant,preoperative creatinine,cardiopulmonary bypass(cardiopulmonary bypass,CPB)time,aorta cross-clamping time,auxiliary circulation time,rewarming time,maximum left cerebral oxygen saturation,minimum right cerebral oxygen saturation,maximum right cerebral oxygen saturation,increment of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation),decrease of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation),postoperative dialysis,total time in the ICU,the time of respirator utilization,peak value of postoperative creatine kinase MB(creatine kinase MB,CK-MB),peak troponin I and prognosis of disease.Logistic regression analysis showed that increment of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation),decrease of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation)and reoperative anticoagulantwas the independent risk factor for early postoperative delirium in patients with aortic dissection or aneurysm.Mantel-Haenszel chi-square test and Kendall’s Tau-B correlation analysis showed that there was no correlation between preoperative anticoagulation and postoperative the highest ICDSC scores.Preoperative creatinine,postoperative dialysis,cardiopulmonary bypass time,aorta cross-clamping time,auxiliary circulation time,rewarming time,maximum left cerebral oxygen saturation,minimum right cerebral oxygen saturation,maximum right cerebral oxygen saturation,increment of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation),decrease of right cerebral oxygen saturation(compared to basal cerebral oxygen saturation),postoperative dialysis,total time in the ICU,the time of respirator utilization,peak value of postoperative creatine kinase MB(creatine kinase MB,CK-MB),peak troponin I were positively correlated with the highest ICDSC scores.There was a negative correlation between the lowest cerebral oxygen on the right side and the highest ICDSC scores.Conclusion: Preoperative anticoagulation and fluctuation of right cerebral oxygen saturation(increasing or decreasing)are independent risk factors for early postoperative delirium.To monitor cerebral oxygen saturation during cardiopulmonary bypass is very important,and monitoring cerebral oxygen saturation on the right side may be more meaningful for predicting postoperative delirium than monitoring cerebral oxygen saturation on the left.