de la Cruz Maxine, Ransing Viraj, Yennu Sriram, Wu Jimin, Liu Diane, Reddy Akhila, Delgado-Guay Marvin, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2015 Dec;20(12):1425-31. doi: 10.1634/theoncologist.2015-0115. Epub 2015 Sep 28.
Delirium is a common neuropsychiatric condition seen in patients with severe illness, such as advanced cancer. Few published studies are available of the frequency, course, and outcomes of standardized management of delirium in advanced cancer patients admitted to acute palliative care unit (APCU). In this study, we examined the frequency, characteristics, and outcomes of delirium in patients with advanced cancer admitted to an APCU.
Medical records of 609 consecutive patients admitted to the APCU from January 2011 through December 2011 were reviewed. Data on patients' demographics; Memorial Delirium Assessment Scale (MDAS) score; palliative care specialist (PCS) diagnosis of delirium; delirium etiology, subtype, and reversibility; late development of delirium; and discharge outcome were collected. Delirium was diagnosed with MDAS score ≥7 and by a PCS using Diagnostic and Statistical Manual, 4th edition, Text Revision criteria. All patients admitted to the APCU received standardized assessments and management of delirium per best practice guidelines in delirium management.
Of 556 patients in the APCU, 323 (58%) had a diagnosis of delirium. Of these, 229 (71%) had a delirium diagnosis on admission and 94 (29%) developed delirium after admission to the APCU. Delirium reversed in 85 of 323 episodes (26%). Half of patients with delirium (n = 162) died. Patients with the diagnosis of delirium had a lower median overall survival than those without delirium. Patients who developed delirium after admission to the APCU had poorer survival (p ≤ .0001) and a lower rate of delirium reversal (p = .03) compared with those admitted with delirium.
More than half of the patients admitted to the APCU had delirium. Reversibility occurred in almost one-third of cases. Diagnosis of delirium was associated with poorer survival.
谵妄是一种常见于重症患者（如晚期癌症患者）的神经精神疾病。关于入住急性姑息治疗病房（APCU）的晚期癌症患者谵妄标准化管理的频率、病程及转归，鲜有发表的研究。在本研究中，我们调查了入住APCU的晚期癌症患者谵妄的频率、特征及转归。
回顾了2011年1月至2011年12月连续入住APCU的609例患者的病历。收集了患者的人口统计学数据、纪念谵妄评估量表（MDAS）评分、姑息治疗专科医生（PCS）对谵妄的诊断、谵妄的病因、亚型及可逆性、谵妄的后期发展情况以及出院转归。谵妄的诊断依据MDAS评分≥7且PCS根据《精神疾病诊断与统计手册》第4版修订版标准做出。所有入住APCU的患者均按照谵妄管理的最佳实践指南接受谵妄的标准化评估和管理。
在APCU的556例患者中，323例（58%）被诊断为谵妄。其中，229例（71%）入院时即被诊断为谵妄，94例（29%）在入住APCU后发生谵妄。323例谵妄发作中有85例（26%）症状逆转。谵妄患者中有一半（n = 162）死亡。诊断为谵妄的患者中位总生存期低于未发生谵妄的患者。与入院时即存在谵妄的患者相比，入住APCU后发生谵妄的患者生存期更差（p≤0.0001）且谵妄逆转率更低（p = 0.03）。
入住APCU的患者中超过一半患有谵妄。近三分之一的病例出现症状逆转。谵妄的诊断与较差的生存期相关。
