Motor Subtypes of Postoperative Delirium in Older Adults
Motor Subtypes of Postoperative Delirium in Older Adults
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DOI：
10.1001/archsurg.2011.14
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发表时间：
2011-03-01
影响因子：
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通讯作者：
Moss, Marc
中科院分区：
文献类型：
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作者：
Robinson, Thomas N.;Raeburn, Christopher D.;Moss, Marc
假设：增加对谵妄运动亚型的了解有助于临床医生对老年患者术后的管理。设计：前瞻性队列研究，确定术前危险因素、结果和与术后谵妄运动亚型相关的不良事件。50岁及以上计划进入术后重症监护室（ICU）的人主要结果：术前进行标准化的虚弱评估。手术后，谵妄和其运动亚型进行了测量，使用确认的工具的混乱评估方法-ICU和里士满激动镇静量表。结果：谵妄发生率为43.0%（74/172），其中少动型50例（67.6%），混合型23例（31.1%），多动型1例（1.4%）。与患有混合性谵妄的患者相比，患有活动减退性谵妄的患者年龄更大（平均[SD]年龄，71 [9] vs 65 [9]岁）且贫血程度更高（平均[SD]红细胞压积，36% [8%] vs 41% [6%]）（两者P= 0.002）。低活动性谵妄患者的6个月死亡率较高（32.0% [16/50] vs 8.7% [2/23]，P= 0.04）。谵妄相关不良事件发生在24.3%（18/74）的谵妄患者中;意外拔管或拔线在混合组中发生率更高（P= 0.001）。骶部皮肤破裂在低活动组更常见（P=. 006）。结论：谵妄的运动亚型提醒临床医生注意老年患者术后不同的预后和不良事件特征。功能减退性谵妄是最常见的运动亚型，预后较差（6个月死亡率，3例患者中有1例）。了解不同的不良事件特征可以改变临床医生对老年术后谵妄患者的治疗。
Hypothesis: Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients.Design: Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium.Setting: Referral medical center.Patients: Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited.Main Outcome Measures: Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and chi(2) tests and analysis of variance with post hoc analysis.Results: Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P=.002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P=.04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P=. 006), and sacral skin breakdown was more common in the hypoactive group (P=. 002).Conclusions: Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.