术后谵妄的预测因素？

本文由“小麻哥的日常”授权转载

术后谵妄（POD）在老年患者全麻术后有一定的发生率，可导致术后并发症发生率增加及住院时间延长，右美托咪定可能有助于POD的防治，但POD确切的发病机制及预防措施还有待进一步探索，那么发现其危险因素，从而尽可能避免在目前阶段显得尤为重要。Jingying Huang 等通过描述性研究发现术后急性瞻仰与POD相关，结果发表在新一期的J Perianesth Nurs. 杂志上。

摘要译文

老年患者急性谵妄作为随后发生的术后谵妄的潜在预测因素：一项描述性相关研究

目的：探讨老年全麻病人急性谵妄（ED）的发生率及其与术后5天的谵妄（ED）的关系。

设计：本研究为描述性相关性研究。

方法：从2018年4月至2018年9月，在华南地区一家拥有2400张床位的综合性三级教学医院，共招募168名老年患者进行选择性全身麻醉。护理谵妄筛查量表用于评估拔管后30分钟和60分钟或出麻醉复苏室（PACU）时的谵妄状态。病人在术后第1天到第5天用同样的方法评估谵妄。收集患者的人口学信息，包括认知功能。

结果：168例老年患者中，58例（34.5%）发生ED，其中46例例患者发生术后谵妄（POD），占79.3%。ED与POD呈正相关（χ2=111.744；P<0.01）。Logistic回归分析包括7个变量：年龄、术前简易精神状态检查评分（MMSE）、潜在疾病、美国麻醉师学会等级、手术时间、术后并发症、是否存在ED。年龄和ED是POD的独立预测因素。

结论：气管拔管后1小时的ED是随后发生的术后5天谵妄的预测因子。复苏期准确及时的评估可以有效指导POD的治疗和康复，最大限度地预防不良后果。

关键词：相关性；老年患者；急性谵妄；术后谵妄。

原文摘要

Emergence Delirium in Elderly Patients as a Potential Predictor of Subsequent Postoperative Delirium: A Descriptive Correlational Study

Purpose: This study aimed to investigate the incidence of emergence delirium (ED) in elderly patients under general anesthesia and to determine the correlation between ED and delirium at five subsequent postoperative days.

Design: This research is a descriptive correlational study.

Methods: A total of 168 aged patients undergoing elective general anesthesia were recruited from a comprehensive tertiary teaching hospital with 2,400 beds in Southern China from April 2018 to September 2018. The Nursing Delirium Screening Scale was used to assess delirium at 30 and 60 minutes after extubation or on discharge from the postanesthesia care unit. Patients were assessed for delirium at postoperative days one through five using the same method. Patients' demographic information, including cognitive function, were collected.

Findings: Among the 168 aged patients, 58 suffered from ED (34.5%), including the 79.3% for the 46 patients who experienced postoperative delirium (POD). A positive correlation existed between ED and POD (χ2 = 111.744; P < .01). Logistic regression analysis included seven variables: age, preoperative Mini-Mental State Examination score, underlying diseases, American Society of Anesthesiologists grade, surgery duration, postoperative complications, and the presence of ED. Age and ED were concluded to be independent predictive factors of POD.

Conclusions: ED in the first hour after tracheal tube removal is a predictor of delirium at five subsequent postoperative days. Accurate and timely assessment of recovery period can effectively guide the treatment and rehabilitation of POD and maximize prevention of adverse consequences.

Keywords: correlation; elderly patients; emergence delirium; postoperative delirium.

文章来源：Huang J, Qi H, Lv K, Chen X, Zhuang Y, Yang L. Emergence Delirium in Elderly Patients as a Potential Predictor of Subsequent Postoperative Delirium: A Descriptive Correlational Study [published online ahead of print, 2020 Jun 20]. J Perianesth Nurs. 2020;S1089-9472(20)30017-4. doi:10.1016/j.jopan.2019.11.009

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文中所涉及药物使用、疾病诊疗等内容仅供参考。

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