Hamann Johannes, Bickel H, Schwaibold H, Hartung R, Förstl H
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Urology. 2005 Mar;65(3):449-53. doi: 10.1016/j.urology.2004.10.004.
To determine the incidence of, and predictors for, the acute confusional state (ACS) in older patients after urologic surgery. ACS is among the most common complications after surgery in older patients. It is associated with increased postoperative morbidity, longer hospital stays, and greater mortality. Agitation caused by ACS might have deleterious consequences in a large proportion of older patients, especially after urologic surgery. Only a few studies, of highly selected urologic procedures, have been reported, and all showed an astonishingly low percentage of patients with this distressing condition.
We examined 100 consecutive, older patients (age 60 years or older), prospectively, before and after urologic surgery, to determine both the incidence of, and the predictors for, ACS.
Only 7 of the 100 patients developed postoperative ACS. The risk factors identified were preoperative cognitive deficits, pre-existing depression, impaired vision, and the operative time.
These results suggest that postoperative ACS is relatively rare after urologic surgical procedures; however, patients who are likely to develop ACS can be identified, prompting consideration for prophylactic antidelirium care.
确定老年患者泌尿外科手术后急性意识模糊状态（ACS）的发生率及预测因素。ACS是老年患者术后最常见的并发症之一。它与术后发病率增加、住院时间延长及死亡率升高相关。ACS所致的躁动可能在很大一部分老年患者中产生有害后果，尤其是在泌尿外科手术后。仅有少数关于高度特定泌尿外科手术的研究报道，且所有研究显示患有这种令人苦恼病症的患者比例低得出奇。
我们前瞻性地对100例连续的老年患者（年龄60岁及以上）在泌尿外科手术前后进行检查，以确定ACS的发生率及预测因素。
100例患者中仅7例出现术后ACS。确定的风险因素为术前认知缺陷、既往抑郁症、视力受损及手术时间。
这些结果表明，泌尿外科手术后术后ACS相对少见；然而，可以识别出可能发生ACS的患者，从而促使考虑进行预防性抗谵妄护理。
