Postoperative delirium and health related quality of life after coronary artery bypass grafting
Postoperative delirium and health related quality of life after coronary artery bypass grafting
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DOI：
10.1080/14017430801939217
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发表时间：
2008-01-01
影响因子：
2.2
通讯作者：
Tarkka, Matti R.
中科院分区：
文献类型：
--
作者：
Loponen, Pertti;Luther, Michael;Tarkka, Matti R.
目标。我们希望在冠状动脉搭桥术(CABG)患者36个月的随访中确定术后精神障碍的决定因素及其对健康相关生活质量(HRQOL)的影响。设计。共对302例患者进行了回顾性分析。采用15D量表对患者的生活质量进行前瞻性评估。临床诊断为妄想症。结果。精神错乱发生率为6.0%。36个月的累积生存率(全死因死亡)无妄想者为96.1%，有妄想者为77.8%。年龄、脑部疾病、慢性心力衰竭、男性、术后肺炎和低输出量综合征是妄想的预测因素。精神分裂症患者需要更多的资源，即重症监护或住院总时间，但在HRQL方面没有积极的变化。此外，术前15D评分高的患者往往在术后前6个月内遭受相当严重但可逆的损害。结论。术前年龄大、病情重、术后病程复杂的患者在冠状动脉旁路移植术后发展为妄想的风险较高。术前状态、术中并发症及精神障碍可能会对未来的HRQL产生负面影响，尤其是术前HRQL水平较高的患者。
Objectives. We wanted to identify determinants for postoperative delirium and its influence on health related quality of life (HRQoL) during 36-month follow-up of coronary artery bypass (CABG) patients. Design. A total of 302 patients were retrospectively analyzed. HRQoL was assessed prospectively by the15D instrument. Delirium was diagnosed clinically. Results. The incidence of delirium was 6.0%. The cumulative survival (all-cause death) in 36 months was 96.1% in patients without delirium and 77.8% in patients with delirium. Age, cerebral disease, chronic heart failure, male gender, postoperative pneumonia and low output syndrome were predictors for delirium. Delirium patients needed more resources i.e. intensive care or total duration of hospitalization and experienced no positive change in HRQoL. Moreover patients with high preoperative 15D score tended to suffer fairly severe but reversible impairment during the first 6 months after the operation. Conclusions. Preoperatively older and sicker patients with complicated postoperative course are at higher risk of developing delirium after CABG. Preoperative status and operative complications together with delirium may exert negative influence on forthcoming HRQoL, which is seen especially in patients with a relatively high preoperative level of HRQoL.