Saporito Andrea, Sturini Evelina
Service of Anesthesiology, Bellinzona Regional Hospital, Via Ospedale 1, 6500, Bellinzona, Switzerland,
J Anesth. 2014 Apr;28(2):198-201. doi: 10.1007/s00540-013-1706-5. Epub 2013 Sep 26.
Postoperative delirium is a recognized complication in populations at risk. The aim of this study is to assess the prevalence of early postoperative delirium in a population without known risk factors admitted to the ICU for postoperative monitoring after elective major surgery. The secondary outcome investigated is to identify eventual independent risk factors among demographic data and anesthetic drugs used.
An observational, prospective study was conducted on a consecutive cohort of patients admitted to our ICU within and for at least 24 h after major surgical procedures. Exclusion criteria were any preexisting predisposing factor for delirium or other potentially confounding neurological dysfunctions. Patients were assessed daily using the confusion assessment method for the ICU scale for 3 days after the surgical procedure. Early postoperative delirium incidence risk factors were then assessed through three different multiple regression models.
According to the confusion assessment method for the ICU scale, 28 % of patients were diagnosed with early postoperative delirium. The use of thiopentone was significantly associated with an eight-fold-higher risk for delirium compared to propofol (57.1% vs. 7.1%, RR = 8.0, χ2 = 4.256; df = 1; 0.05 < p < 0.02).
In this study early postoperative delirium was found to be a very common complication after major surgery, even in a population without known risk factors. Thiopentone was independently associated with an increase in its relative risk.
术后谵妄是高危人群中一种公认的并发症。本研究的目的是评估在因择期大手术后入住重症监护病房（ICU）进行术后监测且无已知危险因素的人群中，术后早期谵妄的患病率。所研究的次要结果是在人口统计学数据和所使用的麻醉药物中确定最终的独立危险因素。
对在大手术期间及术后至少24小时内入住我们ICU的连续队列患者进行了一项观察性前瞻性研究。排除标准为任何先前存在的谵妄易感因素或其他可能混淆的神经功能障碍。术后3天每天使用ICU谵妄评估方法对患者进行评估。然后通过三种不同的多元回归模型评估术后早期谵妄的发病危险因素。
根据ICU谵妄评估方法，28%的患者被诊断为术后早期谵妄。与丙泊酚相比，硫喷妥钠的使用与谵妄风险高八倍显著相关（57.1%对7.1%，RR = 8.0，χ2 = 4.256；自由度 = 1；0.05 < p < 0.02）。
在本研究中，术后早期谵妄被发现是大手术后一种非常常见并发症，即使在无已知危险因素的人群中也是如此。硫喷妥钠与相对风险增加独立相关。
