Osse Robert Jan, Tulen Joke H M, Hengeveld Michiel W, Bogers Ad J J C
Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):344-8; discussion 348. doi: 10.1510/icvts.2008.192278. Epub 2008 Dec 22.
Delirium after cardiac surgery is a risk factor for adverse outcome and even death. Disturbance of motor activity is a core feature of delirium, but hypoactive delirium often remains unrecognized. We explored wrist-actigraphy as a tool to objectively quantify postoperative recovery of 24-h rest-activity patterns to improve the early recognition of delirium after surgery. Motor activity was recorded by wrist-actigraphy after cardiac surgery in 88 patients over 65 years of age. Patients were assessed daily by using the CAM-ICU. Our final analyses were based on 32 non-delirious patients and 38 patients who were delirious on the first day after surgery. The delirious patients showed lower mean activity levels during the first postoperative night (P<0.05), reduced restlessness during the first day (P<0.05), and a lower mean activity of the 5 h with lowest activity within the first 24 h (P=0.01), as compared to the non-delirious patients. Already at a very early stage after cardiac surgery, a difference in motor activity was observed between patients with and without a delirium. As an unobtrusive method, actigraphy has the potential to be a screening method that may lead to early diagnosis and treatment of delirium.
心脏手术后出现谵妄是不良预后甚至死亡的一个危险因素。运动活动障碍是谵妄的一个核心特征，但活动减退型谵妄往往未被识别。我们探索了腕部活动记录仪作为一种工具，以客观量化术后24小时休息 - 活动模式的恢复情况，从而改善对术后谵妄的早期识别。对88例65岁以上心脏手术后患者使用腕部活动记录仪记录运动活动。每天使用CAM - ICU对患者进行评估。我们的最终分析基于32例未发生谵妄的患者和38例术后第一天发生谵妄的患者。与未发生谵妄的患者相比，发生谵妄的患者在术后第一个晚上的平均活动水平较低（P<0.05），第一天的烦躁不安程度降低（P<0.05），并且在最初24小时内活动最低的5小时内平均活动较低（P = 0.01）。在心脏手术后的很早阶段，发生谵妄和未发生谵妄的患者之间就观察到了运动活动的差异。作为一种不引人注意的方法，活动记录仪有潜力成为一种筛查方法，可能有助于谵妄的早期诊断和治疗。
