Kalisvaart Kees J, Vreeswijk Ralph, de Jonghe Jos F M, van der Ploeg Tjeerd, van Gool Willem A, Eikelenboom Piet
Department of Geriatric Medicine, Medical Center Alkmaar, 1800 AM Alkmaar, the Netherlands.
J Am Geriatr Soc. 2006 May;54(5):817-22. doi: 10.1111/j.1532-5415.2006.00704.x.
To evaluate risk factors for postoperative delirium in a cohort of elderly hip-surgery patients and to validate a medical risk stratification model.
Prospective cohort study.
Medical school-affiliated general hospital in Alkmaar, the Netherlands.
Six hundred three hip-surgery patients aged 70 and older screened for risk factors for postoperative delirium.
Predefined risk factors for delirium were assessed on admission. One point was assigned for each of four risk factors present, resulting in three groups: low, intermediate, and high risk. Baseline screening and assessment included the Mini-Mental State Examination, the standardized Snellen test for visual impairment, chart review to determine Acute Physiological and Chronic Health Evaluation II score, and blood urea nitrogen to creatinine ratio. The primary outcome was postoperative delirium, as defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria. All patients were screened daily for delirium.
Incidence of delirium was 3.8% in the low-risk group (P<.001), 11.1% in the intermediate-risk group (P=.27, relative risk (RR)=3.0), and 37.1% in the high-risk group (P<.001, RR=9.8). Cognitive impairment at admission had the highest predictive value for postoperative delirium (coefficient of determination=0.15). Contrary to previous findings, age was an independent predictive factor for delirium. Moreover, postoperative delirium was four times as frequent in acute patients as in elective hip-replacement patients.
The medical risk factor model is valid for elderly hip-surgery patients. Cognitive impairment, age, and type of admission are important risk factors for delirium in this surgical population.
评估一组老年髋关节手术患者术后谵妄的危险因素，并验证一种医疗风险分层模型。
前瞻性队列研究。
荷兰阿尔克马尔一家医学院附属综合医院。
603名年龄在70岁及以上的髋关节手术患者，对其术后谵妄的危险因素进行筛查。
入院时评估谵妄的预定义危险因素。每存在一个危险因素计1分，从而分为三组：低风险、中风险和高风险。基线筛查和评估包括简易精神状态检查表、标准化视力障碍斯内伦测试、确定急性生理与慢性健康状况评价II评分的病历审查，以及血尿素氮与肌酐比值。主要结局为术后谵妄，根据《精神疾病诊断与统计手册》第四版及意识错乱评估方法标准进行定义。所有患者每天进行谵妄筛查。
低风险组谵妄发生率为3.8%（P<0.001），中风险组为11.1%（P=0.27，相对风险（RR）=3.0），高风险组为37.1%（P<0.001，RR=9.8）。入院时的认知障碍对术后谵妄具有最高预测价值（决定系数=0.15）。与既往研究结果相反之处在于，年龄是谵妄的独立预测因素。此外，急性患者术后谵妄的发生率是择期髋关节置换患者的四倍。
该医疗风险因素模型对老年髋关节手术患者有效。认知障碍、年龄和入院类型是该手术人群谵妄的重要危险因素。
