Lin Yiyun, Chen Jian, Wang Zhinong
Department of Cardiothoracic Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
J Card Surg. 2012 Jul;27(4):481-92. doi: 10.1111/j.1540-8191.2012.01472.x.
The aim of this study is to determine the risk factors of delirium after cardiac surgery.
A systematic literature search of MEDLINE, EMBASE, the Cochrane Library, and Science Citation Index limited to 2008 to 2011 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, using delirium assessment tool, reporting at least one risk factor associated with delirium, and available to full text.
The search identified 106 potentially relevant publications; only 25 met selection criteria. Our systematic review revealed 33 risk factors: 17 predisposing and 16 precipitating factors for delirium after elective cardiac surgery. The most established predisposing risk factors were age, depression, and history of stroke, cognitive impairment, diabetes mellitus, and atrial fibrillation. The most established precipitating risk factors were duration of surgery, prolonged intubation, surgery type, red blood cell transfusion, elevation of inflammatory markers and plasma cortisol level, and postoperative complications. Moreover, sedation with dexmedetomidine may significantly predict the absence of postoperative delirium.
Postoperative delirium is related to several risk factors following cardiac surgery. Sedation with dexmedetomidine and fast-track weaning protocols may decrease the incidence of delirium in cardiac surgical patients.
本研究旨在确定心脏手术后谵妄的危险因素。
对MEDLINE、EMBASE、Cochrane图书馆和科学引文索引进行系统的文献检索，检索范围限定在2008年至2011年，并对研究进行综述。符合条件的研究为随机对照试验或队列研究，使用谵妄评估工具，报告至少一个与谵妄相关的危险因素，且有全文可供获取。
检索确定了106篇潜在相关出版物；只有25篇符合入选标准。我们的系统综述揭示了33个危险因素：17个易患因素和16个诱发因素与择期心脏手术后的谵妄有关。最明确的易患危险因素是年龄、抑郁、中风史、认知障碍、糖尿病和心房颤动。最明确的诱发危险因素是手术时间、长时间插管、手术类型、红细胞输血、炎症标志物和血浆皮质醇水平升高以及术后并发症。此外，右美托咪定镇静可能显著预测术后无谵妄。
心脏手术后的谵妄与多种危险因素有关。右美托咪定镇静和快速康复方案可能降低心脏手术患者谵妄的发生率。
