Assessment of the risk of postoperative delirium in elderly patients using E-PASS and the NEECHAM Confusion Scale
Assessment of the risk of postoperative delirium in elderly patients using E-PASS and the NEECHAM Confusion Scale
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DOI：
10.1002/gps.2262
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发表时间：
2009-11-01
影响因子：
4
通讯作者：
Fukata, Shinji
中科院分区：
文献类型：
--
作者：
Hattori, Hideyuki;Kamiya, Junichi;Fukata, Shinji
研究背景随着社会老龄化进程的加快，老年人股骨颈骨折、结直肠癌等外科疾病的发病率呈上升趋势。在这类患者中，术后精神错乱也很常见。一般应从身体和精神两方面对患者进行评估，以预测高危妄想人群。如果是这样的话，可能会更有效地防止精神错乱。本研究使用一种简单实用的行为评定量表NEECHAM迷惑量表和综合评估老年人手术相关压力的方法E-PASS，探讨早期发现老年患者术后精神障碍的可能性。方法选择160例75岁以上的手术患者。其中血管外科野障碍3例，骨科野障碍67例，消化外科野障碍90例。为了全面评估手术相关的压力，使用了E-PASS。此外，我们还评估了认知、日常生活能力(ADL)和生活质量(QOL)。对于精神错乱的诊断和严重程度评估，我们使用了NEECHAM迷惑量表。将NEECHAM评分的分界值设定为20分，术后评分低于20分的患者视为术后精神障碍。结果54.7%的受试者术后出现妄想。NEECHAM评分在术后第1天和第4天之间有所下降，但此后逐渐上升。单因素和多变量分析均显示，术后精神障碍与高龄(80岁以上)、术前低NEECHAM和MMSE评分、术前生活质量和E-PASS有关。MMSE评分<25分或术前NEECHAM评分<27分的老年患者术后精神障碍发生率为76%。结论E-PASS和NEECHAM评分有助于老年患者术后精神障碍的风险评估，有助于早期预防和治疗。版权所有(C)2009 John Wiley&Sons，Ltd.
Background The incidences of surgery-field disorders such as femur neck fracture and colorectal cancer in elderly persons,e have increased with the rapid aging of society. In such patients, postoperative delirium is also frequent. Patients should be generally assessed from the aspect of both physical and mental conditions in order to predict a high-delirium risk group. If so, delirium may be prevented more efficiently. In this study, we investigated whether the early detection of postoperative delirium in elderly patients is possible using a simple, useful behavior-assessing scale, the NEECHAM Confusion Scale, and a method for comprehensively evaluating elderly persons' stress related to surgery, E-PASS.Methods The subjects were 160 patients aged more than 75 years who underwent surgery. Among them, three patients had vascular surgery-field disorders, 67 had orthopedic-field disorders, and 90 had digestive surgery-field disorders. To comprehensively evaluate surgery-related stress, E-PASS was employed. In addition, we assessed recognition, activities of daily living (ADL), and the quality of life (QOL). For delirium diagnosis and severity assessment, we used the NEECHAM Confusion Scale. The cut-off value of the NEECHAM score was established as 20 points, and patients showing values less than this after surgery were regarded as having postoperative delirium. Evaluation was performed until 10 days after surgery.Results Postoperative delirium was noted in 54.7% of the subjects. There was a decrease in the NEECHAM score between the first and fourth postoperative days, but it gradually increased thereafter. Both uni- and multivariate analyses showed that postoperative delirium was associated with an advanced age (more than 80 years), low preoperative NEECHAM and MMSE scores, the preoperative QOL, and E-PASS. In groups showing an MMSE score of less than 25 or a preoperative NEECHAM score of less than 27, the incidence of postoperative delirium was 76%.Conclusion The results suggest that E-PASS and the NEECHAM score facilitate assessment of the risk of postoperative delirium in elderly patients, contributing to early prevention/treatment. Copyright (C) 2009 John Wiley & Sons, Ltd.