Factors associated with postoperative delirium after thoracic surgery
Factors associated with postoperative delirium after thoracic surgery
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DOI：
10.1016/j.athoracsur.2004.06.022
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发表时间：
2005-03-01
影响因子：
4.6
通讯作者：
Yüksel, M
中科院分区：
文献类型：
--
作者：
Yildizeli, B;Özyurtkan, O;Yüksel, M
背景术后谵妄是一种以意识波动为特征的急性意识模糊状态，与发病率和死亡率增加相关。我们分析了胸部手术后谵妄的发生率和危险因素。方法回顾性分析1996 ~ 2003年间432例开胸或胸骨切开术患者的临床资料。术后谵妄的诊断依据《精神疾病诊断与统计手册》第四版。23例患者（5.32%）在术后第2 - 12天（平均4.4 ± 2.6天）发生术后谵妄。男15例，女8例，平均年龄59.4岁（24 ~ 77岁）。与非谵妄组相比，谵妄组年龄较大（59.4 ± 14.6 vs 51.3 ± 15.5岁，p < 0.01），手术时间较长（5.34 ± 1.58 vs 4.38 ± 1.6小时，p = 0.005）。两组的发病率和死亡率无显著差异（分别为56.5%和47.1%; 13.0%和3.66%）。单因素分析显示，年龄大、术后血钠、钾、血糖明显异常、睡眠剥夺、手术时间长、糖尿病是其危险因素（P < 0.05）。根据多变量分析，选择4个因素作为预测风险因素：（1）术后钠、钾或葡萄糖水平明显异常（p = 0.038）;（2）睡眠剥夺（p = 0.05）;（3）年龄（p = 0.033）;（4）手术时间（p = 0.041）。胸外科术后谵妄可能导致较高的发病率和死亡率。密切的术后随访和早期识别诱发因素，如年龄较大，睡眠剥夺，术后钠，钾或葡萄糖水平异常，以及手术时间较长，可以预防术后谵妄的发生。(C)2005年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Postoperative delirium is an acute confusional state characterized by fluctuating consciousness and is associated with increased morbidity and mortality. We analyzed the incidence and risk factors of delirium following thoracic surgery.Methods. All patients (n = 432) who underwent thoracotomy or sternotomy from 1996 to 2003 were analyzed retrospectively. The diagnosis of postoperative delirium was based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria.Results. Postoperative delirium developed in 23 patients (5.32%) between postoperative days 2 to 12 (mean, 4.4 +/- 2.6 days). There were 15 males and 8 females, with a mean age of 59.4 years (24 to 77 years). The delirium group was older (59.4 +/- 14.6 vs 51.3 +/- 15.5 years, p < 0.01) and had a longer operation time than the nondelirious group (5.34 +/- 1.58 vs 4.38 +/- 1.6 hours, p = 0.005). Morbidity and mortality rates were not significantly different between the two groups (56.5% vs 47.1%; 13.0% vs 3.66%, respectively). Univariate analysis showed that the older age, markedly abnormal postoperative levels of sodium, potassium, or glucose, sleep deprivation, operation time, and diabetes mellitus were risk factors (p < 0.05). According to multivariate analyses, four factors were selected as predictive risk factors: (1) markedly abnormal postoperative levels of sodium, potassium, or glucose (p = 0.038); (2) sleep deprivation (p = 0.05); (3) age (p = 0.033); and (4) operation time (p = 0.041).Conclusions. Postoperative delirium may cause higher morbidity and mortality rates after thoracic surgery. Close postoperative follow-up and early identification of predisposing factors such as older age, sleep deprivation, abnormal postoperative levels of sodium, potassium, or glucose, and longer operation time can prevent occurrence of postoperative delirium. (C) 2005 by The Society of Thoracic Surgeons.