Morristown Memorial Hospital, 100 Madison Ave., Morristown, NJ 07962, USA.
Psychosomatics. 2010 Jul-Aug;51(4):320-9. doi: 10.1176/appi.psy.51.4.320.
Delirium is a common complication of myeloablative hematopoietic stem-cell transplantation (HSCT), yet no studies have explored the later effects of an episode of delirium in this setting on patients' decision-making capacity after the acute symptoms of delirium have resolved.
The authors assessed the impact of delirium during the acute phase of myeloablative HSCT on later decision-making capacity.
Decision-making capacity was assessed with the MacArthur Competence Assessment Tool in 19 patients before they received their first HSCT and at 30 and 80 days post-transplantation. Delirium was assessed 3 times per week with the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days pre-transplantation through 30 days post-transplantation.
Although there was little variance in the pre-treatment scores, with most patients showing very high or perfect scores on decision-making abilities, a multivariate regression model showed that delirium was predictive of a lower reasoning score at Day 30 post-transplantation.
Patients who experienced a delirium episode during the acute phase of HSCT were not likely to develop clinically meaningful impairments in decision-making capacity post-transplantation, although they evidenced minor impairment in their reasoning ability.
谵妄是骨髓清除性造血干细胞移植（HSCT）的常见并发症，但尚无研究探讨该环境下谵妄发作对急性谵妄症状缓解后患者决策能力的后续影响。
作者评估了在骨髓清除性 HSCT 急性阶段发生的谵妄对后期决策能力的影响。
使用 MacArthur 能力评估工具在 19 名患者接受首次 HSCT 之前以及移植后 30 天和 80 天进行决策能力评估。在移植前 7 天至移植后 30 天期间，每周使用 Delirium Rating Scale 和 Memorial Delirium Assessment Scale 对谵妄进行 3 次评估。
尽管治疗前的评分差异不大，大多数患者在决策能力方面表现出非常高或完美的分数，但多变量回归模型显示，谵妄与移植后 30 天的推理评分较低相关。
在 HSCT 急性阶段经历谵妄发作的患者在移植后不太可能出现有临床意义的决策能力受损，尽管他们的推理能力出现轻微受损。
