Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery.
Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery.
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DOI：
10.1186/cc13084
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发表时间：
2013-10-29
期刊：
影响因子：
--
通讯作者：
Santos C
中科院分区：
文献类型：
--
作者：
Abelha FJ;Luís C;Veiga D;Parente D;Fernandes V;Santos P;Botelho M;Santos A;Santos C
谵妄是一种急性意识和认知障碍，已被证明与不良结局相关，包括死亡率增加。我们的目的是评估一组外科重症监护病房（SICU）患者术后谵妄的结局。这项前瞻性研究在SICU进行了10个月。根据重症监护谵妄筛查量表（ICDSC）诊断术后谵妄。主要结局是6个月随访时的死亡率。根据对患者术前和SICU出院后6个月进行个人和工具性日常生活活动（ADL）的能力评价，将住院死亡率和依赖性视为次要结局。对于每个二分结局-住院死亡率、6个月随访时死亡率和依赖性-进行单独的多元logistic回归分析，其中包括谵妄作为自变量。另一个分析的结果是健康相关生活质量的变化，使用SF-36（SF-36）测定，在SICU出院前和出院后6个月进行。此外，对于每个SF-36领域，对每个SF-36领域使用单独的多元线性回归模型，SF-36领域的变化作为因变量，谵妄作为自变量。在775名SICU收治的成人中，562名入组研究，其中89名（16%）发生术后谵妄。谵妄是6个月随访时死亡率（OR = 2.562，P <0.001）和住院死亡率（OR = 2.673，P <0.001）的独立危险因素。谵妄也是SICU出院后个人ADL（P-ADL）依赖的独立危险因素（OR = 2.188，P <0.046）。此外，与未发生术后谵妄的患者相比，发生术后谵妄的患者在出院后SF-36领域的下降幅度更大，特别是在身体功能、活力和社会功能方面。术后谵妄是6个月随访死亡率、住院死亡率和SICU出院后P-ADL独立的独立危险因素。这也与术后生活质量的恶化显著相关。
Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients. This prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient’s ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6 months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6 months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable. Of 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR = 2.562, P <0.001) and also for hospital mortality (OR = 2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR = 2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium. Postoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.
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del妄作为重症疾病幸存者长期认知障碍的预测指标。
影响因子：
8.8
作者：
Girard TD;Jackson JC;Pandharipande PP;Pun BT;Thompson JL;Shintani AK;Gordon SM;Canonico AE;Dittus RS;Bernard GR;Ely EW
通讯作者：
Ely EW
老年人del妄后的功能恢复不完全：一项前瞻性队列研究。
影响因子：
4.1
作者：
Andrew, Melissa K;Freter, Susan H;Rockwood, Kenneth
通讯作者：
Rockwood, Kenneth
DOI：
10.1111/j.1532-5415.2000.tb04718.x
发表时间：
2000-06-01
影响因子：
6.3
作者：
Marcantonio, ER;Flacker, JM;Resnick, NM
通讯作者：
Resnick, NM
DOI：
10.1111/j.1532-5415.1983.tb03391.x
发表时间：
1983-01-01
影响因子：
6.3
作者：
KATZ, S
通讯作者：
KATZ, S
DOI：
10.1007/s12630-011-9658-4
发表时间：
2012-03-01
影响因子：
4.2
作者：
Chaput, Alan J.;Bryson, Gregory L.
通讯作者：
Bryson, Gregory L.