Research On The Risk Factors For Delirium Of Stanford Type A Aortic Dissection Patients After Surgery

Objective Retrospective analysis the risk factors of postoperative delirium in p atients with acute type A aortic dissection.Methods We reviewed all the data of the patients who underwent Sun’s procedure(total arch replacement using a tetrafurcate graft with stented elephant trunk implantation)and admitted to ICU post-operatively from January 2016 to December 2017.Patient were divided into delirium group and non-delirium gro up according to the presence or absence of postoperative delirium.Preoperative,intraoperative and postoperative data were collected,analysis the data of patie nt to find high risk factors of delirium after A-type aortic dissection.Results We totally enrolled 129 patients with acute type A aortic dissection an d 49 patients were diagnosed with delirium,with an incidence of 37.98%.Uni variate analysis indicated that there are Significant differences between two gro ups in male(44/49 vs 58/80,P<0.05),stress emotion(28/49 vs 24/80,P<0.01),lower education(34/49 vs 30/80,P<0.01),Intraoperative blood loss(1892.9±890.9 vs 1476.8±931.7,P<0.05),time of cardiopulmonary bypass(211.2±40.3 vs 195.8±38.7,P<0.05),time of selective cerebral perfusion(23.6±3.5 vs21.7±4.5,P<0.05),lowest partial pressure of oxygen Intraoperatively(75.3±13.4 vs 84.2±18.2,P<0.01),peak lactate and gap of lactate during surgery(3.8±1.8 vs 3.1±1.7,P<0.01),postoperative partial pressure of oxygen(86.7±18.7 vs 100.0±24.5,P<0.01),postoperative oxygenation index(134.4±67.6 vs 193.2±80.1,P<0.01)and postoperative hemoglobin(90.3±12.4 vs 95.5±13.0,P<0.05).Multivariate analysis indicated that male(P<0.05),stress emotion(P<0.01),lower education(P<0.01),time of cardiopulmonary bypass and selective cerebral perfusion(P<0.05),postoperative oxygenation index(P<0.01)and postoperative hemoglobin(P<0.05)were independent risk factors for delirium in patients with Stanford A aortic dissection after surgery.Conclusion The incidence of postoperative delirium in patients with type A ao rtic dissection was 37.98%.Male,low education,stress emotion,intraoperative perfusion and oxygen supply,prolonged cardiopulmonary bypass and selective cerebral perfusion as well as low postoperative hemoglobin are independent ri sk factors for postoperative delirium in patients with type A aortic dissection.Early identification of risk factors and timely intervention may help to reduce the incidence of postoperative delirium.