Robinson Thomas N, Raeburn Christopher D, Tran Zung V, Brenner Lisa A, Moss Marc
Department of Surgery, University of Colorado at Denver School of Medicine, 12631 E 17th Ave., Aurora, CO 80045, USA.
Arch Surg. 2011 Mar;146(3):295-300. doi: 10.1001/archsurg.2011.14.
Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients.
Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium.
Referral medical center.
Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited.
Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and χ(2) tests and analysis of variance with post hoc analysis.
Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P = .002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P = .04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P = .006), and sacral skin breakdown was more common in the hypoactive group (P = .002).
Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.
增加对谵妄运动亚型的了解可能有助于临床医生管理老年术后患者。
前瞻性队列研究，确定术前危险因素、结局以及与术后谵妄运动亚型相关的不良事件。
转诊医疗中心。
招募年龄在50岁及以上、计划在择期手术后入住重症监护病房（ICU）的患者。
手术前进行标准化衰弱评估。手术后，使用经过验证的重症监护病房意识模糊评估方法和里士满躁动镇静量表工具测量谵妄及其运动亚型。统计分析包括单因素t检验和χ²检验以及事后分析的方差分析。
43.0%（172例中的74例）患者发生谵妄，其中67.6%（74例中的50例）为活动减退型，31.1%（74例中的23例）为混合型，1.4%（74例中的1例）为活动亢进型。与混合型谵妄患者相比，活动减退型谵妄患者年龄更大（平均[标准差]年龄，71[9]岁对65[9]岁）且贫血更严重（平均[标准差]血细胞比容，36%[8%]对41%[6%]）（两者P均=0.002）。活动减退型谵妄患者6个月死亡率更高（32.0%[50例中的16例]对8.7%[23例中的2例]，P=0.04）。24.3%（74例谵妄患者中的18例）发生与谵妄相关的不良事件；混合型组意外拔管或拔线更频繁（P=0.006），活动减退型组骶部皮肤破损更常见（P=0.002）。
谵妄的运动亚型使临床医生注意到老年术后患者不同的预后和不良事件情况。活动减退型谵妄是最常见的运动亚型，且与更差的预后相关（6个月死亡率为三分之一）。了解不同的不良事件情况可改变临床医生对老年术后谵妄患者的管理方式。
