School of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesthesiology. 2012 Apr;116(4):788-96. doi: 10.1097/ALN.0b013e31824b94fc.
Postoperative delirium, a common complication in the elderly, can occur following any type of surgery and is associated with increased morbidity and mortality; it may also be associated with subsequent cognitive problems. Effective therapy for postoperative delirium remains elusive because the causative factors of delirium are likely multiple and varied.
Patients 65 yr or older undergoing elective knee arthroplasty were prospectively evaluated for postoperative Diagnostic and Statistical Manual of Mental Disorders-IV delirium. Exclusion criteria included dementia, mini-mental state exam score less than 24, delirium, clinically significant central nervous system/neurologic disorder, current alcoholism, or any serious psychiatric disorder. Delirium was assessed on postoperative days 2 and 3 using standardized scales. Patients' preexisting medical conditions were obtained from medical charts. The occurrence of obstructive sleep apnea was confirmed by contacting patients to check their polysomnography records. Data were analyzed using Pearson chi-square or Wilcoxon rank sum tests and multiple logistic regressions adjusted for effects of covariates.
Of 106 enrolled patients, 27 (25%) developed postoperative delirium. Of the 15 patients with obstructive sleep apnea, eight (53%) experienced postoperative delirium, compared with 19 (20%) of the patients without obstructive sleep apnea (P = 0.0123, odds ratio: 4.3). Obstructive sleep apnea was the only statistically significant predictor of postoperative delirium in multivariate analyses.
This is the first prospective study employing validated measures of delirium to identify an association between preexisting obstructive sleep apnea and postoperative delirium.
术后谵妄是老年人的一种常见并发症，可发生于任何类型的手术后，与发病率和死亡率增加有关；它也可能与随后的认知问题有关。由于谵妄的病因可能是多种且多样的，因此对于术后谵妄的有效治疗仍然难以捉摸。
前瞻性评估了 106 例年龄在 65 岁或以上接受择期膝关节置换术的患者是否发生术后《精神障碍诊断与统计手册》第四版谵妄。排除标准包括痴呆、简易精神状态检查评分<24、谵妄、有临床意义的中枢神经系统/神经系统疾病、目前酗酒或任何严重的精神疾病。使用标准化量表在术后第 2 和第 3 天评估谵妄。从病历中获取患者的既往医疗状况。通过联系患者检查其多导睡眠图记录来确认阻塞性睡眠呼吸暂停的发生。使用 Pearson χ2 或 Wilcoxon 秩和检验以及多元逻辑回归分析调整协变量的影响来分析数据。
在纳入的 106 例患者中，有 27 例（25%）发生了术后谵妄。在 15 例患有阻塞性睡眠呼吸暂停的患者中，有 8 例（53%）发生了术后谵妄，而在没有阻塞性睡眠呼吸暂停的 19 例患者中，有 19 例（20%）发生了术后谵妄（P=0.0123，优势比：4.3）。在多变量分析中，阻塞性睡眠呼吸暂停是术后谵妄的唯一具有统计学意义的预测因素。
这是第一项使用经过验证的谵妄测量方法来确定既往阻塞性睡眠呼吸暂停与术后谵妄之间关联的前瞻性研究。
