Department of Surgery, Flinders Medical Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia.
Aust N Z J Psychiatry. 2010 Nov;44(11):1005-11. doi: 10.3109/00048674.2010.495053.
To determine the prognostic risk of incident delirium after cardiac surgery attributable to preoperative affective disorders and Type D personality.
Patients awaiting elective coronary revascularization surgery (N = 158; 20.9% female; 11.4% concomitant valve surgery; age M = 64.7, SD = 10.6) underwent the structured MINI International Neuropsychiatric Interview and completed a measure of Type D personality. Postoperative incident delirium was established prior to discharge from the index hospitalization with structured psychiatric interview.
The prevalence of psychiatric disorders before cardiac surgery was 17.1% for major depression, 7.6% for panic disorder, 10.1% for generalized anxiety disorder, and 13.3% for Type D personality, while there were 49 (31% of total) cases of delirium after surgery. After adjustment for sex, older age, cross-clamp time, haemoglobin (Hb) and psychotropic drug use, major depression was significantly associated with delirium, odds ratio (OR) = 3.86 (95% confidence interval (CI) 1.42 to 10.52, p = 0.001). Adjustment for clinical covariates suggested that Type D personality was not significantly associated with delirium, OR = 2.85 (95%CI 0.97 to 8.38, p = 0.06).
Major depression was significantly associated with incident delirium after cardiac surgery. These findings suggest that the risk of incident delirium attributable to major depression was not merely a reflection of common diagnostic features in prospectively examined cardiac surgery patients.
确定术前情感障碍和 D 型人格特质与心脏手术后新发谵妄的预后风险。
158 例择期冠状动脉血运重建手术患者（女性占 20.9%，同期行瓣膜手术者占 11.4%；年龄 M=64.7，SD=10.6）接受了结构化的 MINI 国际神经精神访谈，并完成了 D 型人格特质的评估。术后新发谵妄在索引住院期间出院前通过结构化精神科访谈确定。
心脏手术前精神障碍的患病率为：重度抑郁症 17.1%、惊恐障碍 7.6%、广泛性焦虑障碍 10.1%、D 型人格 13.3%，而术后有 49 例（占总数的 31%）发生谵妄。在调整性别、年龄较大、体外循环时间、血红蛋白（Hb）和精神药物使用后，重度抑郁症与谵妄显著相关，比值比（OR）=3.86（95%置信区间（CI）1.42 至 10.52，p=0.001）。调整临床协变量后，D 型人格与谵妄无显著相关性，OR=2.85（95%CI 0.97 至 8.38，p=0.06）。
重度抑郁症与心脏手术后新发谵妄显著相关。这些发现表明，新发谵妄的风险归因于重度抑郁症，不仅仅是对前瞻性检查的心脏手术患者进行共同诊断特征的反映。
