术后谵妄是老年患者创伤后应激障碍的独立危险因素：一项前瞻性观察研究。
Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study.
作者信息
Drews Tanja, Franck Martin, Radtke Finn M, Weiss Björn, Krampe Henning, Brockhaus Wolf R, Winterer Georg, Spies Claudia D
机构信息
From the Department of Anaesthesiology and Surgical Intensive Care Medicine, Campus-Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany *Both Tanja Drews and Martin Franck contributed equally.
出版信息
Eur J Anaesthesiol. 2015 Mar;32(3):147-51. doi: 10.1097/EJA.0000000000000107.
BACKGROUND
Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor.
OBJECTIVE
The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients.
DESIGN
A prospective, clinical observational study.
SETTING
This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia.
INCLUSION CRITERIA
at least 60 years of age; noncardiac surgery with general anaesthesia.
EXCLUSION CRITERIA
impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression.
STATISTICS
Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed.
RESULTS
A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor).
CONCLUSION
The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery.
TRIAL REGISTRATION
ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/
背景
老年患者接受全身麻醉手术后可能会出现创伤后应激障碍（PTSD）。这种情况下的患病率和危险因素尚不清楚。术后谵妄可能是一个危险因素。
目的
本研究的目的是确定老年患者全身麻醉手术后3个月时PTSD的患病率及其危险因素。
设计
一项前瞻性临床观察研究。
地点
本研究于2009年3月至2010年5月在柏林的一家德国大学医院进行，是一项关于麻醉深度的大型研究的一部分。
纳入标准
年龄至少60岁；接受全身麻醉的非心脏手术。
排除标准
术前认知功能受损[简易精神状态检查（MMSE）评分<24]；预计手术时间少于1小时；德语不熟练。
干预措施
无。
主要观察指标
术后3个月使用创伤后应激综合征14项问卷评分（PTSS-14）筛查PTSD。对术后3个月PTSD的以下危险因素进行检测：年龄；美国麻醉医师协会身体状况分级；性别；麻醉持续时间；术后谵妄；术后7天的PTSS-14评分；术后呕吐和恶心；术后疼痛；以及术前抑郁。
统计学方法
采用Fisher精确检验和Spearman相关性进行单变量统计分析。进行向后逻辑回归分析。
结果
1277例患者中共有559例被纳入研究。66例患者（12%）在术后3个月被诊断为PTSD。77例患者（14%）出现术后谵妄。向后逻辑回归分析中的独立相关因素为术后谵妄（危险因素）和术前抑郁（保护因素）。
结论
使用PTSS-14筛查工具时，老年患者术后3个月PTSD的患病率较高。术后谵妄是术后3个月PTSD的一个危险因素。
试验注册
国际标准随机对照试验编号注册库：36437985。http://www.controlled-trials.com/ISRCTN36437985/
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