| 朱守强,薄靳华,顾小萍.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,2026,30(8):1674-1680. |
| 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 |
| Association between early use of acetaminophen and delirium after cardiac surgery: an observational cohort study |
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| DOI：10.3969/j.issn.1009-6469.2026.08.038 |
| 中文关键词: 对乙酰氨基酚 心脏外科手术 术后谵妄 倾向性评分 重症监护病房 |
| 英文关键词: Acetaminophen Cardiac surgical procedures Postoperative delirium Propensity Score Intensive care unit |
| 基金项目: |
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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人次加强监护病房( 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病人，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病人分为两组: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: ICU混淆评估法( CAM-ICU)和重症谵妄筛查清单(ICDSC)。所有病人在术后住院期间由护理团队进行定期(每日至少 1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 3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，我们使用了重症监护医学信息库第四版( MIMIC-Ⅳ)数据库(2008—2019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、心力衰竭和糖尿病)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。结果共纳入接受心脏手术且术后有谵妄评估记录的病人 911例，其中对乙酰氨基酚组 327例，对照组 584例。对乙酰氨基酚组术后谵妄发生率低于对照组［ 12.23%(40/327)比 22.09%(129/584)］(P<0.001)。倾向评分匹配后，对乙酰氨基酚组术后谵妄发生率仍低于对照组［12.97%(31/239)比 20.92%(50/239)］(P=0.013)。调整混杂因素后，对乙酰氨基酚用药与更低的术后谵妄发生风险相关［倾向评分匹配模型 OR=0.49，95%CI:(0.29，0.82)P=0.008；逆概率治疗加权模型 OR=0.53，95%CI:(0.33，0.85)P=0.009；重叠加权模型 OR=0.56，95%CI:(0.35，0.88)P=0.012］外，对乙酰氨基酚组院内死亡率低于对照组［1.22%(4/327)3.94%(23/584)］，总住院时间短于对照组［ 8.03(6.121.85)d比 8.88(6.27，12.96)d］(均 P<0.05)。验证数据集( MIMIC)结果与本研究主要结果一。此致。亚组分析显示，术前合并症(高血压、心肌梗死、心力衰竭和糖尿病)未显著影响对乙酰氨基酚对术后谵妄的保护作用。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 ofpostoperative delirium following cardiac surgery.Methods A retrospective analysis was conducted using ICU admission records from208 hospitals in the United States between 2014 and 2015, comprising a total of 200,859 ICU admissions. Data from the eICU Collabor-ative Research Database were extracted for patients who underwent cardiac surgery and had delirium assessment records postoperative-ly. Baseline demographics, comorbidities, laboratory tests, and postoperative medication data were collected. Patients were divided intotwo groups based on whether they received acetaminophen treatment within 48 hours postoperatively: the acetaminophen group and thecontrol group. Delirium was diagnosed using two commonly used tools: the confusion assessment method for the ICU (CAM-ICU) andthe intensive care delirium screening checklist (ICDSC). All patients were regularly assessed (at least once daily) by the nursing teamduring their postoperative hospital stay to ensure timely diagnosis and documentation of delirium. Multivariable logistic regression andthree propensity score methods were used to evaluate the association between early postoperative acetaminophen use and delirium. Tovalidate the results of this study, we used the medical information mart for intensive care Ⅳ (MIMIC-Ⅳ) database (2008-2019) as an ex-ternal validation dataset. Additionally, we performed subgroup analyses on preoperative comorbidities (such as hypertension, myocardi-al infarction, heart failure, and diabetes) to further explore the interaction between acetaminophen and these important comorbidities. |
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