Pi-Figueras M, Aguilera A, Arellano M, Miralles R, Garcia-Caselles P, Torres R, Cervera A M
Universidad Autónoma de Barcelona, Servicio de Geriatría del IMAS, I-08022 Barcelona, Spain.
Arch Gerontol Geriatr Suppl. 2004(9):333-7. doi: 10.1016/j.archger.2004.04.062.
The aim was to evaluate the prevalence of delirium among patients discharged from an acute care hospital and admitted to a geriatric convalescence unit (GCU), and to analyze patient's characteristics and risk precipitating factors. Sixty-eight patients were analyzed during a 2-week period. The confusion assessment method (CAM) was used to detect delirium. The precipitating factors evaluated were: major surgery-intensive care unit(ICU) stay, pulmonary and heart failure, acute infections, metabolic disorders/anemia,psychoactive medications, other drugs, severe pain, changing environmental influences and others. According to CAM, fifteen patients presented delirium (22%), and in 14 of them(93.3 %) the delirium was developed before admission at GCU. The precipitating factors in the studied population were the following: changing environmental influences in 66 patients(97%) (15 with delirium and 51 without delirium); other drugs 56 (82.3 %) (11 vs. 45);others 56 (82.3%) (9 vs. 24); psychoactive medications 50 (73.5%) (12 vs. 38); acute infections 48 (70.5 %) (13 vs. 35); metabolic disorders/anemia 40 (58.8 %) (9 vs. 31); major surgery-ICU stay 28 (41 .1%) (8 vs. 20); severe pain 26 (38.2%) (6 vs. 20); pulmonary and heart failure 22 (32.3%) (5 vs. 17). The univariant analysis showed that, none of the precipitating factors studied was significantly related to delirium. Seventy-two patients (91.1%) had simultaneously >3 precipitating factors. There were 16 patients with >6 precipitating factors, 7 of 15 with delirium and 9 of the 53 without delirium (46.6 % vs 16.9 %) (p < 0.05). The prevalence of delirium has been 22 %. Most of the patients had developed delirium before the admission at GCU. A high proportion of patients had >3 precipitating factors. In the study the presence of > 6 precipitating factors simultaneously has been significantly related to delirium.
本研究旨在评估从急性护理医院出院并入住老年康复病房(GCU)的患者中谵妄的患病率,并分析患者特征及风险诱发因素。在为期2周的时间里,对68例患者进行了分析。采用意识模糊评估法(CAM)来检测谵妄。评估的诱发因素包括:大手术、入住重症监护病房(ICU)、肺和心力衰竭、急性感染、代谢紊乱/贫血、精神活性药物、其他药物、剧痛、环境影响改变及其他因素。根据CAM评估,15例患者出现谵妄(22%),其中14例(93.3%)在入住GCU之前就已发生谵妄。研究人群中的诱发因素如下:环境影响改变66例(97%)(15例有谵妄,51例无谵妄);其他药物56例(82.3%)(11例有谵妄,45例无谵妄);其他因素56例(82.3%)(9例有谵妄,24例无谵妄);精神活性药物50例(73.5%)(12例有谵妄,38例无谵妄);急性感染48例(70.5%)(13例有谵妄,35例无谵妄);代谢紊乱/贫血40例(58.8%)(9例有谵妄,31例无谵妄);大手术-入住ICU 28例(41.1%)(8例有谵妄,20例无谵妄);剧痛26例(38.2%)(6例有谵妄,20例无谵妄);肺和心力衰竭22例(32.3%)(5例有谵妄,17例无谵妄)。单因素分析显示,所研究的诱发因素均与谵妄无显著相关性。72例患者(91.1%)同时存在>3种诱发因素。有16例患者存在>6种诱发因素,15例有谵妄的患者中有7例,53例无谵妄的患者中有9例(46.6%对16.9%)(p<0.05)。谵妄的患病率为22%。大多数患者在入住GCU之前就已发生谵妄。高比例患者存在>3种诱发因素。在本研究中,同时存在>6种诱发因素与谵妄显著相关。