【罂粟摘要】术后谵妄是影响老年患者在重症监护病房和医院住院时间长短的独立因素

术后谵妄是影响老年患者在重症监护病房和医院住院时间长短的独立因素

贵州医科大学    麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟  审校：曹莹

0  1 背景

术后谵妄(POD)是一中不常被发现的老年人术后不良事件。通过适当筛查(PROPDESC)试验对70岁及以上患者进行术前预测术后谵妄的亚组分析，目的是确定术前危险因素以及POD对ICU和医院住院时间(LOS)的影响。

0  2 方法

在2018年9月至2019年10月德国的一大学医院招募了1097名患者，通过PROPDESC试验筛查对其行前瞻性观察研究，其中588名年龄在70岁及以上的患者(平均年龄77.2 4.7岁)被纳入亚组分析。如果在术后5个随访天数中，下列任何一项试验阳性，则认为POD阳性:ICU的混淆评估方法（CAM-ICU），混淆评估方法（CAM）、4'A（4AT）和谵妄观察量表（DOS）。由接受过培训的医生进行上述探访，此外，为了完成DOS，对护理人员对患者进行了相关情况了解。采用多变量线性回归分析方法，探讨POD对ICU和住院患者住院时间的独立影响。

0  3 结果

POD发病率为25.9%。我们的筛查结果显示POD是ICU患者（36%；95%可信区间4-78%；<0.001）和医院住院患者（22%；95%可信区间4-43%；<0.001）。

0  4

结论：POD对ICU和住院患者的住院时间有独立影响。根据POD对老年人的影响，需要进行标准化的风险筛查。

原始文献来源:

Andrea Kirfel, Vera Guttenthaler,Andreas Mayr, Mark Coburn,JanMenzenbach, MariaWittmann.Postoperative delirium is an independent factor infuencing the length of stay of elderly patients in the intensive care unit and in hospital.Journal of Anesthesia https://doi.org/10.1007/s00540-022-03049-4

英文原文：   

Postoperative delirium is an independent factor infuencing the length of stay of elderly patients in the intensive care unit and in hospital

 Abstract

 Purpose Postoperative delirium (POD) is an often unrecognized adverse event in older people after surgery. The aim of this subgroup analysis of the PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) trial in patients aged 70 years and older was to identify preoperative risk factors and the impact of POD on length of stay (LOS) in intensive care unit (ICU) and hospital.

Methods Of the total 1097 patients recruited at a German university hospital (from September 2018 to October 2019) in the PROPDESC prospective observational study, 588 patients aged 70 years and older (mean age 77.2±4.7 years) were included for subgroup analysis. The primary endpoint POD was considered positive if one of the following tests were positive on any of the fve postoperative visit days: Confusion Assessment Method for ICU (CAM-ICU), Confusion Assessment Method (CAM), 4'A's (4AT) and Delirium Observation Scale (DOS). Trained doctoral students carried out these visitations and additionally the nursing staf were interviewed for completion of the DOS. To evaluate the independent efect of POD on LOS in ICU and in hospital, a multi-variable linear regression analysis was performed.

Results The POD incidence was 25.9%. The results of our model showed POD as an independent predictor for a prolonged LOS in ICU (36%; 95% CI 4–78%;<0.001) and in hospital (22%; 95% CI 4–43%;<0.001).

Conclusion POD has an independent impact on LOS in ICU and in hospital. Based on the efect of POD for the elderly, a standardized risk screening is required.

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