Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study
Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study
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DOI：
10.1016/j.jpsychores.2010.02.009
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发表时间：
2010-08-01
影响因子：
4.7
通讯作者：
Kloszewska, Iwona
中科院分区：
文献类型：
--
作者：
Kazmierski, Jakub;Kowman, Maciej;Kloszewska, Iwona
目的：心脏手术后谵妄是一种严重的并发症，可导致较高的发病率和死亡率，并导致住院时间延长。然而，关于术后谵妄问题的知识基础仍然有限。因此，在本研究中，我们评估了心脏手术后谵妄的发生率和独立的围手术期危险因素。方法：IPDACS研究招募了563例连续接受体外循环心脏手术的患者。受试者术前由精神科医生使用简易精神状态检查和简易国际神经精神访谈评估精神共病。此外，还评估了与患者医疗状况、手术和麻醉程序有关的其他变量。根据精神疾病诊断与统计手册第四版（DSM-IV）标准诊断手术干预后谵妄。结果：根据DSM-IV标准，术后谵妄的发生率为16.3%（95%置信区间：13.5-19.6）。多因素逐步Logistic回归分析显示，高龄、术前认知功能障碍、持续性抑郁发作、贫血、房颤、长时间插管和术后缺氧与心脏手术后谵妄独立相关。结论：根据目前的分析，上述条件独立易患谵妄心脏手术后。由于这些因素中的一些可以在术前和术后成功治疗和消除，因此本研究应有助于降低谵妄风险并改善接受心脏手术患者的医疗护理（临床试验标识符：NCT 00784576）。(C)2010年爱思唯尔公司All rights reserved.
Objective: Delirium after cardiac surgery is a serious complication that results in higher morbidity and mortality rates, and prolongs hospitalisation. However, the knowledge base regarding the issue of postoperative delirium is still limited. Therefore, in the current study, we evaluated the incidence and independent perioperative risk factors of delirium after cardiac surgery. Methods: The IPDACS Study recruited 563 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass. The subjects were preoperatively examined by psychiatrists using the Mini-Mental State Examination and the Mini International Neuropsychiatric Interview to assess psychiatric comorbidity. Additionally, other variables connected to the patients' medical condition and surgical and anaesthetic procedures were evaluated. A diagnosis of delirium following surgical intervention was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Results: The incidence of postoperative delirium according to DSM-IV criteria was 16.3% (95% confidence interval: 13.5-19.6). Multivariate stepwise logistic regression analysis revealed that advanced age, preoperative cognitive impairment, an ongoing episode of major depression, anaemia, atrial fibrillation, prolonged intubation and postoperative hypoxia were independently associated with delirium after cardiac surgery. Conclusion: According to the current analysis, the aforementioned conditions independently predispose to delirium following cardiac surgery. Since some of these factors can be successfully treated and eliminated preoperatively and postoperatively, this study should be helpful in reducing the risk of delirium and in improving the medical care of patients undergoing cardiac surgery (Clinical Trials Identifier: NCT00784576). (C) 2010 Elsevier Inc. All rights reserved.