Factors associated with recovery from early postoperative delirium.
Factors associated with recovery from early postoperative delirium.
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DOI：
10.1016/j.jopan.2011.03.001
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发表时间：
2011-08
期刊：
影响因子：
--
通讯作者：
Leung JM
中科院分区：
文献类型：
--
作者：
DeCrane SK;Sands L;Ashland M;Lim E;Tsai TL;Paul S;Leung JM
谵妄已被证明发生在14-56%的术后住院老年人中，使其成为老年患者最常见的术后并发症之一。本研究的目的是确定术后第一天（POD 1）至术后第二天（POD 2）与谵妄恢复相关的因素。这一假设是，那些疼痛较轻的人更有可能在POD 2前从谵妄中恢复过来。纳入了65岁或以上的患者，这些患者计划接受非心脏手术，会说英语，并且通过混淆评估方法（CAM）检测到在POD 1发生谵妄。总样本量为176例患者。术后第二天的谵妄也用CAM测量。术后第1天和第2天使用数字评定量表（NRS）评估术后疼痛。从患者病历中提取术后止痛药。176例患者在POD 1发生谵妄，66例（38%）在POD 2从谵妄中恢复。从谵妄中恢复的患者的平均年龄为72.5 ± 5.7岁（N=66），而未从谵妄中恢复的患者的平均年龄为75.9 ± 6.5岁（N=110）。多变量logistic回归显示，年龄小于75岁的患者更有可能从谵妄中恢复（OR=2.31; 95% CI=1.18-4.53; p=0.015），第2天疼痛评分小于5的患者也是如此（OR=2.59; 95% CI=1.26-5.35; p=0.0098）。疼痛水平较低（NRS 4或更低）的患者更有可能在POD 2从谵妄中恢复。术后疼痛治疗的类型（使用或不使用患者自控镇痛）与谵妄的恢复无关。结果表明，积极的疼痛管理，在术后48小时内可能是重要的，以促进术后谵妄的恢复。
Delirium has been shown to occur in 14-56% of postoperative, hospitalized elderly persons, making it one of the most common postoperative complications for the older patient. The aim of this study was to determine factors associated with recovery of delirium from postoperative day one (POD 1) to postoperative day two (POD 2). The hypothesis was that those with less pain are more likely to recover from delirium by POD 2. Patients aged 65 or older who were scheduled for noncardiac surgery, spoke English, and who developed delirium on POD 1 as detected by the Confusion Assessment Method (CAM) were included. Total sample size was 176 patients. Postoperative delirium on day two was also measured with the CAM. Postoperative pain was assessed on POD 1 and 2 using the Numeric Rating Scale (NRS). Postoperative pain medications were abstracted from patient medical records. One hundred seventy six patients developed delirium on POD 1 with 66 (38%) recovering from delirium by POD 2. The mean age of those patients who recovered from delirium was 72.5 ± 5.7 (N=66) while the mean age of those patients who did not recover from delirium was 75.9 ± 6.5 (N=110). Multivariate logistic regression revealed that patients less than age 75 were more likely to recover from delirium (OR=2.31; 95% CI=1.18-4.53; p=0.015) as were patients who had pain scores of less than 5 on day two (OR=2.59; 95% CI=1.26-5.35; p=0.0098). Patients with lower pain levels (NRS 4 or less) were more likely to recover from delirium on POD 2. The type of postoperative pain therapy (the use or non-use of patient controlled analgesia) was not related to the recovery of delirium. The results suggest that aggressive pain management in the first 48 hours postoperatively may be important in promoting recovery from postoperative delirium.
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影响因子：
4
作者：
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