| 朱守强.心脏手术后早期使用对乙酰氨基酚与谵妄的相关性分析：一项观察性队列研究[J].安徽医药,待发表. |
| 心脏手术后早期使用对乙酰氨基酚与谵妄的相关性分析：一项观察性队列研究 |
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| 投稿时间：2025-05-06 录用日期：2025-06-04 |
| DOI： |
| 中文关键词: 对乙酰氨基酚 心脏手术 术后谵妄 倾向性评分 |
| 英文关键词: |
| 基金项目:南京鼓楼医院临床研究专项资金项目(2021-LCYJ-DBZ-04，2024-LCYJ-MS-18)、国家自然科学基金重点和面上项目(81730033, 82171193) |
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| 中文摘要: |
| 目的 分析心脏手术后早期使用对乙酰氨基酚与术后谵妄的相关性。方法 回顾性分析2014—2015年美国208家医院的200 859人次ICU入院记录,从电子重症监护室协作研究数据库提取接受心脏手术且术后具有谵妄评估记录的患者,提取基线人口统计、合并症、实验室检验、术后用药等资料。根据术后48 h内是否接受对乙酰氨基酚治疗将患者分为两组：对乙酰氨基酚组和对照组。谵妄的诊断采用了两种常用工具：CAM-ICU(Confusion Assessment Method for the ICU)和ICDSC(Intensive Care Delirium Screening Checklist)。所有患者在术后住院期间内由护理团队进行定期(每日至少一次)评估,以确保谵妄的及时诊断和记录。采用多变量逻辑回归和三种倾向评分方法评估术后早期对乙酰氨基酚与谵妄的相关性。为了验证本研究的结果,我们使用了MIMIC-IV(Medical Information Mart for Intensive Care, version 4)数据库(2008年至2022年)作为外部验证数据集。此外,我们对术前合并症(如高血压、心肌梗死、心衰和糖尿病)进行了亚组分析,以进一步探讨对乙酰氨基酚与这些重要合并症的交互作用。 结果 本研究共纳入911例接受心脏手术且术后有谵妄评估记录的患者。其中,对乙酰氨基酚组327例,对照组584例。两组基线人口统计学方面没有统计学差异。在调整混杂因素后,对乙酰氨基酚用药与更低的谵妄发生率相关(倾向评分匹配模型OR = 0.492, 95%CI = 0.288-0.828, P = 0.008；逆概率治疗加权模型OR = 0.534, 95%CI = 0.334-0.852, P = 0.009；重叠加权模型OR = 0.555, 95%CI =0.352-0.876, P = 0.012)。验证数据集(MIMIC-IV)与本研究的主要发现一致。亚组分析显示,术前合并症(高血压、心肌梗死、心衰和糖尿病)并未显著影响对乙酰氨基酚对术后谵妄发生率的保护效应。结论 心脏手术后早期使用对乙酰氨基酚可能与较低的术后谵妄发生风险相关,但仍需进一步研究以确认其因果关系。 |
| 英文摘要: |
| Objective: To assess the association between early postoperative acetaminophen administration and the occurrence of postoperative delirium following cardiac surgery. Methods: A retrospective analysis was conducted using ICU admission records from 208 hospitals in the United States between 2014 and 2015, comprising a total of 200,859 ICU admissions. Data from the eICU Collaborative Research Database were extracted for patients who underwent cardiac surgery and had delirium assessment records postoperatively. Baseline demographics, comorbidities, laboratory tests, and postoperative medication data were collected. Patients were divided into two groups based on whether they received acetaminophen treatment within 48 hours postoperatively: the acetaminophen group and the control group. Delirium was diagnosed using two commonly used tools: the CAM-ICU (Confusion Assessment Method for the ICU) and the ICDSC (Intensive Care Delirium Screening Checklist). All patients were regularly assessed (at least once daily) by the nursing team during their postoperative hospital stay to ensure timely diagnosis and documentation of delirium. Multivariable logistic regression and three propensity score methods were used to evaluate the association between early postoperative acetaminophen use and delirium. To validate the results of this study, we used the MIMIC-IV (Medical Information Mart for Intensive Care, version 4) database (2008–2022) as an external validation dataset. Additionally, we performed subgroup analyses on preoperative comorbidities (such as hypertension, myocardial infarction, heart failure, and diabetes) to further explore the interaction between acetaminophen and these important comorbidities. Results: A total of 911 patients who underwent cardiac surgery and had postoperative delirium assessment records were included in this study. Among them, 327 patients received acetaminophen, and 584 patients were in the control group. No significant differences in baseline demographics were found between the two groups. After adjusting for confounding factors, acetaminophen use was associated with a lower incidence of delirium (propensity score-matched model: OR = 0.492, 95% CI = 0.288–0.828, P = 0.008; inverse probability treatment weighting model: OR = 0.534, 95% CI = 0.334–0.852, P = 0.009; overlap weighting model: OR = 0.555, 95% CI = 0.352–0.876, P = 0.012). The validation dataset (MIMIC-IV) confirmed the main findings of this study. Subgroup analyses showed that preoperative comorbidities (hypertension, myocardial infarction, heart failure, and diabetes) did not significantly affect the protective effect of acetaminophen on postoperative delirium incidence. Conclusion: The early use of acetaminophen after cardiac surgery may be associated with a lower risk of postoperative delirium, but further research is needed to confirm its causal relationship. |
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