Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery
Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery
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DOI：
10.1007/s40520-017-0736-5
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发表时间：
2018-01-01
影响因子：
4
通讯作者：
Okita, Yutaka
中科院分区：
文献类型：
--
作者：
Ogawa, Masato;Izawa, Kazuhiro P.;Okita, Yutaka
背景：术后谵妄（POD）是心脏外科手术的一种严重并发症，与死亡率和主要并发症密切相关。识别患者的风险为POD是至关重要的，但还没有得到充分explored.Aims本研究的目的是确定术前运动能力的评估POD.Methods的预测价值，我们招募了313例连续患者（平均年龄68.6 +/- 14.8岁）接受择期心脏手术。我们在手术前测量了身体功能，如6分钟步行距离（6 MWD）和定时起立行走试验（TUG）。采用重症监护谵妄筛查量表（IntensiveCareDeliriumScreenChecklist），从手术当天至术后第5天，每8 h对患者进行一次谵妄评估。年龄、6 MWD、TUG、血清血红蛋白、估计的肾小球滤过率和重症监护室停留时间基于POD的存在或不存在而显著不同（每个p < 0.05）。多变量分析后，6 MWD仍然是发展POD的统计学显著指标（OR 0.98; p = 0.02）。6 MWD预测POD的临界值为345 m（AUC = 0.75; p = 0.001）。结论运动能力差是心脏手术后POD的独立预测因子。这一发现表明术前功能评估在心脏手术患者POD的预防和管理中的重要性。
Background Postoperative delirium (POD) is a critical complication that is closely associated with mortality and major morbidity in elective cardiac surgery. The identification of patients at risk for POD is crucial but has not been fully explored.Aims The aim of this study was to determine the predictive value of the assessment of preoperative exercise capacity for POD.Methods We enrolled 313 consecutive patients (mean age, 68.6 +/- 14.8 years) undergoing elective cardiac surgery. We measured physical functions such as the 6-minute walking distance (6MWD) and Timed Up-and-Go test (TUG) before surgery. The assessment of delirium was conducted every 8 h from the day of surgery to 5 days after surgery using the Intensive Care Delirium Screening Checklist.Results POD occurred in 46 patients (14.6%). Age, 6MWD, TUG, serum hemoglobin, estimated glomerular filtration rate, and length of intensive care unit stay were significantly different based on the presence or absence of POD (p < 0.05 for each). After multivariate analysis, 6MWD remained a statistically significant indicator for developing POD (OR 0.98; p = 0.02). The cut-off value of 6MWD for predicting POD was 345 m (AUC = 0.75; p = 0.001).Conclusions Poor exercise capacity was found to be an independent predictor of POD following elective cardiac surgery. This finding suggests the importance of preoperative functional evaluation in the prevention and management of POD in cardiac surgery patients.