Nursing and Paramedical Care for People With Chronic Illnesses, University of Applied Science Utrecht, Faculty of Health Care, Bolognalaan 101, 3584 CJ Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Int J Nurs Stud. 2014 Feb;51(2):251-60. doi: 10.1016/j.ijnurstu.2013.05.011. Epub 2013 Jun 21.
OBJECTIVE(S): The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications.
We systematically reviewed the literature following the PRISMA statement guidelines.
Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population.
Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients.
心脏外科手术后并发症的文献表明，术后并发症如谵妄、抑郁、压疮、感染、肺部并发症和心房颤动的发生率较高。这些并发症与功能和认知能力下降以及出院后生活质量下降有关。一些研究试图通过术前干预来预防一种或多种术后并发症。在这里，我们提供了一个综合概述，包括旨在预防术后并发症的单一和多种成分的入院前干预措施。
我们按照 PRISMA 声明指南系统地审查了文献。
在 1335 篇初始引文中有 31 篇进行了批判性评估。最后，有 23 项研究被纳入，从中我们得出了一份可以在入院前应用的干预措施清单，这些干预措施可以有效地降低老年择期心脏手术患者的术后抑郁、感染、肺部并发症、心房颤动、延长重症监护病房停留时间和住院时间。没有发现高质量的研究描述了预防术后谵妄的有效干预措施。我们没有发现专门针对预防该患者群体压疮的研究。
多成分方法包括不同的单一干预措施，对预防术后抑郁、肺部并发症、延长重症监护病房停留时间和住院时间具有最强的效果。术后感染可通过氯己定消毒联合免疫增强营养补充剂来预防。心房颤动可通过摄入 N-3 多不饱和脂肪酸来预防。迫切需要高质量的研究来评估入院前预防策略，以减少老年择期心脏手术患者的术后谵妄或压疮。
