Ringaitienė Donata, Gineitytė Dalia, Vicka Vaidas, Žvirblis Tadas, Šipylaitė Jūratė, Irnius Algimantas, Ivaškevičius Juozas, Kačergius Tomas
Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania.
Center of Anesthesia and Intensive care Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, Lt 08448, Lithuania.
J Cardiothorac Surg. 2015 May 20;10:74. doi: 10.1186/s13019-015-0278-x.
BACKGROUND & AIMS: Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting.
We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium.
Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173).
Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting.
尽管在心脏疾病患者中经常观察到营养不良，但关于营养不良患者心脏手术后的人群结局数据却非常罕见。尚未针对营养不良对心脏手术后神经心理结局的影响进行全面研究。我们研究的目的是分析接受体外循环冠状动脉搭桥术的营养不良患者术后谵妄的发生率。
我们对维尔纽斯大学医院桑塔里斯基诊所收治的择期冠状动脉搭桥术成年患者进行了一项队列研究。术前一天通过2002年营养风险筛查（NRS - 2002）问卷评估患者的营养状况。当NRS - 2002评分小于3时，患者被认为没有营养不良风险；当NRS - 2002评分≥3时，患者被认为有营养不良风险。在重症监护病房（ICU）住院期间，使用CAM - ICU方法对患者进行术后谵妄筛查，并分为两组：谵妄组和非谵妄组。进行统计分析以评估两个独立组之间的差异。使用逻辑回归模型评估术后谵妄的潜在术前和术中危险因素。
99名患者纳入研究。24%（n = 24）的患者术前存在营养不良风险。总体研究人群中术后早期谵妄的发生率为8.0%（n = 8）。谵妄组中存在营养不良风险的患者发生率显著更高（5例（62.5%）对19例（20.9%），p < 0.0191）。在多因素逻辑回归分析中，NRS 2002定义的营养不良风险是冠状动脉搭桥术后术后谵妄的独立术前和术中危险因素（比值比：6.316，95%置信区间：1.384 - 28.819，p = 0.0173）。
择期冠状动脉搭桥术患者术前营养不良很常见。营养缺乏与体外循环冠状动脉搭桥术后早期术后谵妄有关。
