Chu Che-Sheng, Liang Chih-Kuang, Chou Ming-Yueh, Lin Yu-Te, Hsu Chien-Jen, Chou Po-Han, Chu Chin-Liang
Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Gen Hosp Psychiatry. 2016 Jan-Feb;38:15-20. doi: 10.1016/j.genhosppsych.2015.08.006. Epub 2015 Sep 1.
Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery.
Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24 ± 7.92 years). The MNA-SF was used to evaluate preoperative nutritional status. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD.
POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernutrition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Examination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to develop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19-6.87).
These results suggest that the MNA-SF is a simple and effective tool that can be used to predict incident delirium in elderly patients after orthopedic surgery.
术后谵妄（POD）是接受手术的老年患者主要关注的问题，常导致不良后果。因此，预测和预防POD很重要。本研究的目的是评估简易营养评估量表简表（MNA-SF）作为骨科手术后POD的预测指标。
纳入2011年4月至2013年3月接受骨科手术的老年患者（n = 544；平均年龄74.24±7.92岁）。使用MNA-SF评估术前营养状况。术后每天使用意识模糊评估法评估谵妄。采用《精神障碍诊断与统计手册（第四版），修订版》标准确诊谵妄诊断。进行单因素和多因素逻辑回归分析以确定与POD相关的关键因素。
52例患者（9.6%）发生POD。根据MNA-SF，17.5%的受试者存在营养不良风险。在最终模型中对所有潜在因素进行校正后，年龄、男性、较低的简易精神状态检查表评分和较高的查尔森合并症指数评分与POD发生可能性显著增加相关。术前被确定为有营养不良风险的受试者发生POD的可能性是营养正常受试者的2.85倍（比值比：2.85，95%置信区间：1.19 - 6.87）。
这些结果表明，MNA-SF是一种简单有效的工具，可用于预测老年患者骨科手术后发生谵妄的情况。
