接受择期冠状动脉旁路移植手术患者的谵妄、亚综合征性谵妄及认知变化。
Delirium, subsyndromal delirium, and cognitive changes in individuals undergoing elective coronary artery bypass graft surgery.
作者信息
Li Hsiu-Ching, Chen Yih-Sharng, Chiu Ming-Jang, Fu Mei-Chiung, Huang Guan-Hua, Chen Cheryl Chia-Hui
机构信息
Hsiu-Ching Li, RN, MSN Head Nurse, Department of Nursing, Sijhih Cathay General Hospital, New Taipei City, Taiwan. Yih-Sharng Chen, MD, PhD Professor, Director, Department of Cardiac Surgery, National Taiwan University and National Taiwan University Hospital, Taipei. Ming-Jang Chiu, MD, PhD Associate Professor, Department of Neurology, National Taiwan University and National Taiwan University Hospital, Taipei. Mei-Chiung Fu, RN, MSN Nursing Director, Department of Nursing, Sijhih Cathay General Hospital, New Taipei City, Taiwan. Guan-Hua Huang, PhD Professor, Director, Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan. Cheryl Chia-Hui Chen, RN, DNSc Associate Professor, Department of Nursing, National Taiwan University and National Taiwan University Hospital.
出版信息
J Cardiovasc Nurs. 2015 Jul-Aug;30(4):340-5. doi: 10.1097/JCN.0000000000000170.
BACKGROUND
The course of incident delirium and subsyndromal delirium (SSD) after cardiac surgery is not well studied.
OBJECTIVE
The aim of this study was to evaluate the course of incident delirium and SSD, their risk factors, and impact on patients' cognitive function after elective coronary artery bypass graft (CABG) surgery.
METHODS
Consecutive patients scheduled for an isolated CABG at a tertiary medical center in Taiwan were enrolled if they had no preoperative delirium symptoms. Delirium was assessed daily for 1 week after surgery using the Confusion Assessment Method. Subsyndromal delirium was defined as presenting with any core symptom below the diagnostic threshold for delirium. Cognitive function was assessed by the Mini-mental State Examination.
RESULTS
Of 38 participants, 7 had incident (first-time) delirium (18.4% incidence) and 13 had incident SSD (34.2% incidence). Whereas SSD usually lasted 1 day, delirium changed gradually to SSD to recovery and its symptomatology lasted longer. We identified 6 delirium risk factors: older age, more comorbidities, cardiac pulmonary bypass, blood transfusion, larger transfusion volume, and longer duration of intraoperative blood pressure less than 60 mm Hg. The frequencies of these risk factors for SSD were often intermediate between those of risk factors in groups with and without delirium. By hospital discharge, participants with delirium had the longest hospital stays and lowest cognitive scores, those with SSD had intermediate stays and scores, and those without delirium had the lowest stays and scores.
CONCLUSION
Delirium and SSD after CABG are common. Greater number and severity of risk factors for delirium may predict increasingly poor outcomes, with the dose-response relationship between risk factors and outcomes for SSD intermediate between that for no symptoms and full delirium. Intervention trials are indicated, particularly for patients with a greater number and severity of predisposing and precipitating risk factors.
背景
心脏手术后新发谵妄和轻度谵妄（SSD）的病程尚未得到充分研究。
目的
本研究旨在评估择期冠状动脉旁路移植术（CABG）后新发谵妄和SSD的病程、危险因素及其对患者认知功能的影响。
方法
在台湾一家三级医疗中心计划接受单纯CABG手术且术前无谵妄症状的连续患者被纳入研究。术后1周每天使用意识模糊评估法评估谵妄情况。轻度谵妄定义为出现低于谵妄诊断阈值的任何核心症状。通过简易精神状态检查表评估认知功能。
结果
38名参与者中，7人发生新发（首次）谵妄（发病率为18.4%），13人发生新发SSD（发病率为34.2%）。SSD通常持续1天，而谵妄逐渐转变为SSD至恢复，其症状持续时间更长。我们确定了6个谵妄危险因素：年龄较大、合并症较多、体外循环、输血、输血量较大以及术中血压低于60 mmHg的持续时间较长。这些SSD危险因素的发生频率通常介于有谵妄组和无谵妄组危险因素的发生频率之间。到出院时，发生谵妄的参与者住院时间最长，认知评分最低，发生SSD的参与者住院时间和评分中等，未发生谵妄的参与者住院时间最短，评分最高。
结论
CABG术后谵妄和SSD很常见。谵妄危险因素的数量和严重程度越高，可能预示预后越差，SSD危险因素与预后之间的剂量反应关系介于无症状和完全谵妄之间。需要进行干预试验，特别是针对具有更多数量和更严重的易感和促发危险因素的患者。
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