心脏手术后术前衰弱与术后谵妄之间的关联
The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery.
作者信息
Brown Charles H, Max Laura, LaFlam Andrew, Kirk Lou, Gross Alden, Arora Rakesh, Neufeld Karin, Hogue Charles W, Walston Jeremy, Pustavoitau Aliaksei
机构信息
From the *Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and †Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; ‡Department of Surgery, University of Manitoba, St. Boniface Hospital, Winnipeg, Mannitoba, Canada; §Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and ‖Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Anesth Analg. 2016 Aug;123(2):430-5. doi: 10.1213/ANE.0000000000001271.
Delirium is common after cardiac surgery, and preoperative identification of high-risk patients could guide prevention strategies. We prospectively measured frailty in 55 patients before cardiac surgery and assessed postoperative delirium using a validated chart review. The prevalence of frailty was 30.9%. Frail patients had a higher incidence of delirium (47.1%) compared with nonfrail patients (2.6%; P < 0.001). In multivariable models, the relative risk of delirium was ≥2.1-fold greater in frail compared with nonfrail patients (relative risk, 18.3; 95% confidence interval, 2.1-161.8; P = 0.009). Frailty may identify patients who would benefit from delirium-prevention strategies because of increased baseline risk for delirium.
谵妄在心脏手术后很常见，术前识别高危患者可指导预防策略。我们前瞻性地测量了55例心脏手术患者术前的虚弱程度，并通过经过验证的图表回顾评估术后谵妄情况。虚弱的患病率为30.9%。与非虚弱患者（2.6%；P<0.001）相比，虚弱患者谵妄的发生率更高（47.1%）。在多变量模型中，与非虚弱患者相比，虚弱患者发生谵妄的相对风险高≥2.1倍（相对风险为18.3；95%置信区间为2.1 - 161.8；P = 0.009）。由于谵妄的基线风险增加，虚弱可能识别出可从谵妄预防策略中获益的患者。
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