Veiga Dalila, Luis Clara, Parente Daniela, Fernandes Vera, Botelho Miguela, Santos Patricia, Abelha Fernando
Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal.
Rev Bras Anestesiol. 2012 Jul;62(4):469-83. doi: 10.1016/S0034-7094(12)70146-0.
Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD.
Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI).
There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality
There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery.
外科重症监护患者术后谵妄（POD）是一个重要的独立预后决定因素。我们研究的目的是评估POD的发生率及其决定因素。
在一个设有五张重症监护床位的麻醉后护理单元（PACU）进行了为期10个月的前瞻性队列研究。纳入所有接受大手术的连续成年患者。记录人口统计学数据、围手术期变量、住院时间（LOS）以及在PACU、医院和6个月随访时的死亡率。使用重症监护谵妄筛查清单（ICDSC）评估术后谵妄。进行描述性分析，并使用Mann-Whitney检验、卡方检验或Fisher精确检验进行比较。逻辑回归分析通过计算比值比（OR）及其95%置信区间（95%CI）来评估POD的决定因素。
共有775例成年患者入住PACU，95例患者有排除标准。在其余680例患者中，128例（18.8%）发生了POD。确定的POD独立决定因素为年龄、美国麻醉医师协会身体状况分级（ASA-PS）、急诊手术以及手术期间输注的新鲜冰冻血浆总量。发生谵妄的患者死亡率更高，病情更严重，在PACU和医院的停留时间更长。POD是医院死亡的独立危险因素。
重症监护外科患者中谵妄的发生率很高。POD与疾病严重程度评分更差、在医院和PACU的住院时间更长以及死亡率更高相关。POD的独立危险因素为年龄、ASA-PS、急诊手术以及手术期间输注的血浆量。
