Bilge Emel Ünal, Kaya Menşure, Şenel Gülçin Özalp, Ünver Süheyla
Clinic of Anaesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2015 Aug;43(4):232-9. doi: 10.5152/TJAR.2015.93798. Epub 2015 Mar 3.
In this study, we aimed to determine the risk factors and the incidence of delirium in patients who were followed postoperatively in our surgical intensive care unit for 24 h using the confusion assessment method (CAM).
After obtaining approval from the ethics committee, 250 patients were included in the study. Patients who were operated under general anaesthesia or regional anaesthesia and followed in the surgical intensive care unit were evaluated by the Ramsay Sedation Scale on the first postoperative day. CAM was applied to the patients who had a Ramsey Sedation Score of ≤4. Patients' age, gender, American Society of Anesthesiologists (ASA) scores, preoperative risk factors, type of anaesthesia, operation time, intra-operative procedures, pain scores evaluated by the visual analogue scale (VAS) and postoperative analgesia methods were recorded.
The incidence of delirium was found to be 18.4%. The average age of patients who developed delirium was greater than the others (68.8±12.7 and 57.6±12, p=0.001, respectively). It was observed that a one-unit increase in the ASA score resulted in a 3.3-fold increase in the risk of delirium. The incidence of delirium in patients undergoing regional anaesthesia was 34.6%, whereas it was 16.5% in patients receiving general anaesthesia (p=0.024). The existence of preoperative diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) was shown to improve the development of delirium (p<0.05). Delirium incidence was significantly higher in patients who were administered meperidine for postoperative analgesia (p=0.013). The VAS scores of patients who developed delirium were found to be significantly higher (p=0.006).
As a result, we found that older age, high ASA score, preoperative DM and COPD are important risk factors for the development of delirium. Regional anaesthesia, high postoperative pain scores and meperidine use were observed to be associated with the development of delirium. In the postoperative period, addition of CAM, a simple measurement technique, to the daily follow-up forms can provide the early recognition of delirium, which is often underdiagnosed. We think that identification and prevention of effective risk factors have the primary importance for postoperative delirium.
在本研究中，我们旨在使用意识模糊评估法（CAM）确定在我院外科重症监护病房术后接受24小时随访的患者中谵妄的危险因素及发生率。
在获得伦理委员会批准后，250例患者纳入本研究。在全身麻醉或区域麻醉下手术并在外科重症监护病房接受随访的患者在术后第一天采用Ramsay镇静评分进行评估。CAM应用于Ramsay镇静评分为≤4分的患者。记录患者的年龄、性别、美国麻醉医师协会（ASA）评分、术前危险因素、麻醉类型、手术时间、术中操作、采用视觉模拟评分法（VAS）评估的疼痛评分及术后镇痛方法。
发现谵妄发生率为18.4%。发生谵妄的患者平均年龄大于未发生谵妄的患者（分别为68.8±12.7岁和57.6±12岁，p = 0.001）。观察到ASA评分每增加一个单位，谵妄风险增加3.3倍。接受区域麻醉患者的谵妄发生率为34.6%，而接受全身麻醉患者的谵妄发生率为16.5%（p = 0.024）。术前存在糖尿病（DM）和慢性阻塞性肺疾病（COPD）被证明会增加谵妄的发生（p<0.05）。术后使用哌替啶镇痛的患者谵妄发生率显著更高（p = 0.013）。发生谵妄的患者VAS评分显著更高（p = 0.006）。
因此，我们发现高龄、高ASA评分、术前DM和COPD是谵妄发生的重要危险因素。观察到区域麻醉、术后疼痛评分高和使用哌替啶与谵妄的发生有关。在术后期间，在日常随访表格中增加CAM这种简单的测量技术可实现对常常诊断不足的谵妄的早期识别。我们认为识别和预防有效的危险因素对术后谵妄至关重要。
