背景：先天性心脏病（congenital heart disease,CHD,以下简称先心病）是我国常见的出生缺陷类型，也是我国5岁以下儿童的前5位死亡原因之一，严重危害儿童的健康。作为适应证广泛且最有成效的治疗方式，手术治疗提高了患儿生存率的同时，也带来了一系列术后并发症。其中，先心病患儿术后谵妄（postoperative delirium，POD）从2017年起才开始受到医学界关注。现有研究显示先心病患儿POD发病率较高（49%~59.1%），不仅会延长患儿机械通气时间及住院时间，还会增加拔管、自残的危险，是一个不容忽视的问题。目前国内外有关先心病患儿POD发生现状及危险因素的研究数量非常有限，不同研究所得的先心病患儿POD独立危险因素存在很大差异，术前焦虑、术后用药剂量、术后疼痛等因素曾被报道与成人心脏术后POD相关，但从未在先心病患儿群体中进行探索，与此同时暂无先心病患儿POD亚型（活动过度型、活动减退型、混合型）发生情况的报道。故本研究前瞻性地描述了国内先心病患儿POD的发生现状及危险因素，为尽早预测POD高危患儿及预防措施的制订提供参考依据。

目的：描述并分析国内先心病患儿术后谵妄的发生现状及危险因素。

方法：选取2020年12月至2021年6月于北京市某三级甲等心血管病专科医院完成先天性心脏病外科手术的患儿进行前瞻性观察。根据康奈尔儿童谵妄评估量表（the Cornell assessment of pediatric delirium，CAPD）的评估结果，了解先天性心脏病患儿POD的发生现状；同时应用二分类非条件Logistic回归分析探索先天性心脏病患儿术后谵妄的危险因素。

结果：共纳入216例患儿，其中114例患儿发生了POD（52.78%）；三种谵妄类型的发生概率无显著差异（P=0.729）；谵妄开始时间以术后第一日居多（50.88%）；在发生POD的患儿中，54.39%的患儿POD仅持续1天。二分类非条件Logistic回归分析显示，年龄（OR=0.951，P<0.001）、性别（OR=2.127，P=0.049）、每日有创导管留置数量（OR=1.490，P=0.017）、术前家长焦虑程度（OR=1.025，P=0.010）、术后疼痛程度（OR=5.856，P<0.001）是先天性心脏病患儿术后谵妄的独立危险因素。利用上述5个变量构建先心病患儿POD风险预测模型，该模型的受试者工作特征曲线下面积为0.842，灵敏度为0.876，特异度为0.690，其预测概率值与先心病患儿实际发生POD的拟合较好。

结论：POD在先心病患儿群体中发生率较高，且容易在术后早期发生。年龄越小、男性、每日有创导管留置数量越多、术前陪护家长焦虑程度越高、术后疼痛程度越高的先心病患儿， POD发生风险越高。术后早期识别和干预POD对于先心病术后患儿具有重要意义。

Background: Congenital heart disease (CHD) is a common type of birth defect in China, and is also one of the top 5 causes of death for children under 5 years old in China, which seriously endangers children's health. As the most effective treatment with extensive indications, surgical treatment improves the survival rate of children, but also causes a number of postoperative complications. Among them, postoperative delirium (POD) in children with CHD has not been concerned by the medical community until 2017.  Existing studies show that the incidence of POD in children with CHD is high (49% - 59.1%),which would not only prolong the mechanical ventilation time and hospital stay, also increase the risk of extubation and self-disability in children, which is an unignorable problem. At present, the number of studies on status quo and risk factors of POD in children with CHD at home and abroad is very limited, and the independent risk factors of POD in children with CHD in different studies are very different. Preoperative anxiety, postoperative medication dose, postoperative pain and other factors have been reported to be associated with POD after cardiac surgery in adults, but they have never been explored in children with CHD. At the same time, POD subtypes (hyperactive delirium,hypoactive delirium,mixed delirium) have not been reported in children with CHD. Therefore, this study prospectively analyzed the status quo and risk factors of POD in children with CHD in China, so as to provide a reference for early prediction of children at high risk of POD and the development of prevention measures.

Objective: To describe and analyze the status quo and risk factors of POD in children with CHD in China.

Methods: A total of 216 children with CHD who underwent surgery in a tertiary cardiovascular hospital in Beijing from December 2020 to June 2021 were prospectively observed. The status quo of POD in children with CHD was evaluated according to the results of the Cornell assessment of pediatric delirium (CAPD). At the same time, the risk factors of POD in children with CHD were explored by binary logistic regression analysis.

Results: A total of 216 children were included, 114 of whom developed POD (52.78%). The three types of delirium had statistically similar rates of occurrence (P=0.729). The onset time of POD was most on the first postoperative day (50.88%). POD lasted only 1 day in 54.39% of the children who developed it. Binary logistic regression analysis showed that age (OR=0.951, P<0.001), gender (OR=2.127, P=0.049),number of invasive catheters per day (OR=1.490, P=0.017), preoperative parental anxiety level (OR=1.025, P=0.010) and postoperative pain degree (OR=5.856, P<0.001) were independent influencing factors of POD in children with CHD. The above five variables were used to construct the POD risk prediction model for children with CHD,and the area under the receiver operating characteristic curve of the model was 0.842, the sensitivity was 0.876, and the specificity was 0.690. The predicted probability value of the model fitted well with the actual occurrence of POD in children with CHD.

Conclusion: POD has a high incidence in children with CHD, and it is more likely to occur in the early postoperative stage. The risk of POD increases in children with CHD who are younger, male, have higher number of invasive catheters per day, higher preoperative parental anxiety level, and higher degree of postoperative pain. Early postoperative identification and intervention of POD is of great significance for children with CHD.