McGuire Jason M
University of San Diego, CA, USA.
J Perianesth Nurs. 2012 Aug;27(4):236-45. doi: 10.1016/j.jopan.2012.05.004.
The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, P<.05. There was a positive relationship between ED in veterans who reported greater amounts of anxiety, PTSD symptoms, and depression [state anxiety: r(128)=0.40, P<.001; trait anxiety: r(128)=0.40, P<.001; PTSD: r(128)=0.35, P<.001; and depression: r(128)=0.25, P=.002]. This study revealed the incidence of ED and identified anxiety, PTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment.
本研究的目的是确定彭德尔顿海军陆战队基地海军医院美国军事作战退伍军人外科手术人群中苏醒期谵妄（ED）的发生率及潜在风险因素。ED是一种麻醉后现象，发生在全身麻醉苏醒后即刻，其特征为躁动、意识混乱及暴力行为。临床证据表明，在从伊拉克和阿富汗战争归来的军事人员中，ED越来越常见，且该人群中焦虑、抑郁及创伤后应激障碍（PTSD）的发生率高于非作战部队或非军事人群。在这130名有作战经历的术后军事人员样本中，ED的发生率为20%（n = 26）。先前被诊断患有心理障碍的人员ED发生率（50%）高于未患心理障碍者（17.5%），χ(2)=5.53，P<.05。报告有较多焦虑、PTSD症状及抑郁的退伍军人中，ED之间存在正相关关系[状态焦虑：r(128)=0.40，P<. .001；特质焦虑：r(128)=0.40，P<.001；PTSD：r(128)=0.35，P<.001；抑郁：r(128)=0.25，P=.002]。本研究揭示了ED的发生率，并确定焦虑、PTSD及抑郁为风险因素。回归模型表明状态焦虑是最佳预测因素。这些发现增进了临床医生对作战退伍军人中ED的理解，并为未来应侧重于预防性治疗的研究指明了方向。
