Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
J Cardiothorac Vasc Anesth. 2011 Dec;25(6):968-74. doi: 10.1053/j.jvca.2011.05.004. Epub 2011 Jul 8.
The authors' intention was to evaluate the incidence of the three subtypes of delirium, the risk factors of the subtypes in cardiac surgery, and the impact of the subtypes on clinical outcomes.
A prospective study.
A university hospital.
A total population of 506 patients undergoing cardiac surgery was screened for delirium.
None.
Patients undergoing cardiac surgery were screened by using the Intensive Care Delirium Screening Checklist (ICDSC) and the Richmond Agitation and Sedation Scale (RASS). Patients with hypoactive delirium were compared with nondelirious patients. Outcomes measured were the duration of mechanical ventilation and the length of stay in the intensive care unit. The overall delirium incidence was 11.6%, whereas the incidence of the hypoactive subtype was 9%. Age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.09, p = 0.02), a history of depression (OR = 3.57; 95% CI, 1.04-10.74; p = 0.03), preoperative therapy with diuretics (OR = 2.85; 95% CI, 1.36-6.35; p < 0.01), aortic clamping times (OR = 1.01; 95% CI, 1.00-1.02; p < 0.01) and blood transfusions (OR = 1.18; 95% CI, 1.05-1.34; p < 0.01) were predictors for the development of hypoactive delirium. Preoperative therapy with β-blockers (OR = 0.32; 95% CI, 0.16-0.65; p < 0.01) and higher hemoglobin before surgery (OR = 0.73; 95% CI, 0.60-0.91; p < 0.01) were associated with a lower prevalence of hypoactive delirium. Hypoactive delirium is an independent predictor for prolonged mechanical ventilation time (OR = 1.56; 95% CI, 1.25-1.92; p < 0.01) and the length of stay in the ICU (OR = 1.42; 95% CI, 1.22-1.65, p < 0.01).
Hypoactive delirium itself is a strong predictor for a longer ICU stay and a prolonged period of mechanical ventilation. Some of the risk factors related to the intraoperative and postoperative setting are suitable for preventive action.
作者旨在评估三种类型谵妄的发生率、心脏手术中各亚型的危险因素以及各亚型对临床结局的影响。
前瞻性研究。
一所大学医院。
对接受心脏手术的 506 例患者进行了谵妄筛查。
无。
使用重症监护谵妄筛查检查表（ICDSC）和 Richmond 躁动和镇静量表（RASS）对接受心脏手术的患者进行了筛查。将出现低反应性谵妄的患者与非谵妄患者进行了比较。测量的结果是机械通气时间和重症监护病房（ICU）住院时间。总的谵妄发生率为 11.6%，而低反应性亚型的发生率为 9%。年龄（比值比[OR] 1.04；95%置信区间[CI]，1.01-1.09，p=0.02）、抑郁症病史（OR=3.57；95%CI，1.04-10.74；p=0.03）、术前利尿剂治疗（OR=2.85；95%CI，1.36-6.35；p<0.01）、主动脉夹闭时间（OR=1.01；95%CI，1.00-1.02；p<0.01）和输血（OR=1.18；95%CI，1.05-1.34；p<0.01）是低反应性谵妄发生的预测因素。术前使用β受体阻滞剂（OR=0.32；95%CI，0.16-0.65；p<0.01）和术前较高的血红蛋白水平（OR=0.73；95%CI，0.60-0.91；p<0.01）与低反应性谵妄的发生率较低有关。低反应性谵妄是机械通气时间延长（OR=1.56；95%CI，1.25-1.92；p<0.01）和 ICU 住院时间延长（OR=1.42；95%CI，1.22-1.65，p<0.01）的独立预测因素。
低反应性谵妄本身是 ICU 住院时间延长和机械通气时间延长的一个强有力的预测因素。一些与围手术期相关的危险因素适合采取预防措施。
