Emergence delirium in adults in the post-anaesthesia care unit
Emergence delirium in adults in the post-anaesthesia care unit
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DOI：
10.1093/bja/ael094
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发表时间：
2006-06-01
影响因子：
9.8
通讯作者：
Leon, A.
中科院分区：
文献类型：
--
作者：
Lepouse, C.;Lautner, C. A.;Leon, A.
背景麻醉后监护室（PACU）中的紧急谵妄知之甚少。这项前瞻性研究的目的是确定成人全麻后出现谵妄的频率和危险因素。在这项前瞻性研究中，纳入了1359例连续患者。根据Riker镇静量表记录背景风险因素和谵妄发生率。根据是否发生激越进行分组，然后排除术前焦虑和抗精神病药物或两者同时使用，以及抗抑郁药或苯二氮卓类药物治疗的患者。64名（4.7%）患者在PACU中出现谵妄，可能从抽搐到暴力行为和拔管。未发现术前焦虑是危险因素。苯二氮卓类药物术前用药（OR=1.910，95%CI =1.101-3.315，P=0.021），乳房手术（OR=5.190，95%CI =1.422-18.947，P=0.013），腹部手术（OR=3.206，95%CI =1.262-8.143，P=0.014），手术时间长增加了谵妄发生的风险（OR=1.005，95%CI =1.002-1.008，P=0.001），而既往病史和长期抗抑郁药治疗可降低风险OR=0.544，95%CI =0.315-0.939，P=0.029; OR=0.245，95%CI =0.084-0.710，P=0.010。术前苯二氮卓类药物、胸部和腹部手术以及手术时间过长是发生谵妄的危险因素。
Background. Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia.Methods. In this prospective study, 1359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments.Results. Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010).Conclusions. Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.