| Objective:To explore the relationship between preoperative physical performance(grip strength,walking speed and timed up and go test)and postoperative delirium of patients undergoing cardiac surgery,providing a new predictive index for the occurrence of postoperative delirium in patients with cardiac surgery.Methods:In this study,patients who underwent cardiac surgery in a cardiovascular tertiary hospital in Tianjin from September 2019 to November 2020 were selected as the research subjects.The general and perioperative data of the subjects were collected by the hospital information system.Physical performance assessment tool was used to measure grip strength,walking speed and timed up and go test,reflecting the muscle strength,mobility and balance in physical performance,resperately.The delirium of the patients within 5 days after cardiac surgery was evaluated by CAM-ICU at 8:00/20:00 twice a day.To explore the related factors of delirium according to whether delirium occurs after cardiac surgery.T test and chi-square test were used to compare general data,perioperative data and physical performance between the two groups.Logistic regression was used to analyze the relationship between preoperative physical performance and postoperative delirium after cardiac surgery.The ROC curve of postoperative delirium was drawn to explore the prediction of postoperative delirium after cardiac surgery.Results:1.In this study,350 patients underwent cardiac surgery were investigated.After exclusion,340 cases were effective.According to whether delirium occurred after cardiac surgery,patients were divided into delirium group(n=93)and non delirium group(n=247).Postoperative delirium occurred in 93 of the 340 patients.The incidence rate of delirium undergoing cardiac surgery was 27.35%(95%CI=22.68～32.42).2.Comparison of general data between the delirium group and the non-delirium group univariate analysis showed that age,body mass index,gender and education were associated with postoperative delirium undergoing cardiac.The difference between the two groups was statistically significant(P<0.05).Compared with the non-delirium group,the delirium group had higher age,female proportion and educational level(illiteracy and primary school proportion),but lower body mass index,male proportion and educational level(secondary school and above proportion).3.Comparison of perioperative data between the delirium group and the non-delirium group univariate analysis showed that blood transfusion and hemoglobin were associated with postoperative delirium undergoing cardiac.The difference between the two groups was statistically significant(P<0.05).Compared with the non-delirium group,the delirium group had lower intraoperative blood transfusion proportion and hemoglobin.4.Comparison of preoperative performance between the delirium group and the non-delirium group univariate analysis showed that grip strength,walking speed and duration of timed up and go test were associated with postoperative delirium undergoing cardiac surgery.The difference between the two groups was statistically significant(P<0.05).The delirium group timed up and go test longer than the non-delirium group.Grip strength and walking speed were lower than those in the non-delirium group.Logistic regression analysis,after adjusting for confounding factors,multivariate analysis showed that grip strength(OR=0.930,95%CI=0.882～0.979)and walking speed(OR=0.039,95%CI=0.006～0.235)were negatively correlated with postoperative delirium,and duration of the timed up and go test(OR=1.202,95%CI=1.024～1.412)was positively correlated with postoperative delirium.5.ROC curve was drawn between physical performance(grip strength,walking speed and timed up and go test)and postoperative delirium.The AUC of grip strength was 0.716,95%CI=0.658～0.773(P<0.001).The maximum Youden index was 0.380,the sensitivity was 0.817,the specificity was 0.563,and the cutoff value was 32.4kg.The AUC of walking speed was0.726,95%CI=0.665～0.787(P<0.001).The maximum Youden index was0.347,the sensitivity was 0.777,the specificity was 0.570,and the cut-off value of walking speed was 0.90m/s.The AUC of timed up and go test was0.723,95%CI=0.660～0.786(P<0.001).The maximum Youden index was0.355,the sensitivity was 0.785,the specificity was 0.570,and the cut-off value of timed up and go test was 8.96 s.Conclusion:1.There is a correlation between physical performance and postoperative delirium undergoing cardiac surgery.Preoperative grip strength and walking speed were negatively correlated with postoperative delirium.Preoperative duration of timed up and go test was positively correlated with postoperative delirium.Low preoperative grip strength,slow walking speed and duration of timed up and go test were independent risk factors for postoperative delirium undergoing cardiac surgery.2.Preoperative grip strength,walking speed and timed up and go test can be used as predictors of postoperative delirium,meanwhile,preoperative grip strength and walking speed has moderate predictive value for the occurrence of postoperative delirium undergoing cardiac surgery. |
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