Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Int J Surg. 2016 Nov;35:1-6. doi: 10.1016/j.ijsu.2016.09.001. Epub 2016 Sep 6.
Postoperative delirium is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. It is of great importance to identify patients at risk for delirium, in order to focus preventive strategies. The aim of this article is to systematically review current available literature on pre-operative risk factors for delirium after vascular surgery.
A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "delirium", "surgery" and "risk factor". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for delirium in patients who had elective vascular surgery. Diagnosis of delirium needed to be confirmed using the Diagnostic and Statistical Manual of Mental Disorders (DSM) or ICD-10.
Fifteen articles were selected for inclusion, incidence of delirium across the studies ranged from 5% to 39%. Many factors have been associated with increased risk of delirium, including age, cognitive impairment, comorbidity, depression, smoking, alcohol, visual and hearing impairment, ASA-score, biochemical abnormalities, operative strategies and blood loss.
Delirium is a common complication after elective vascular surgery in elderly. The highest delirium incidence was observed after open aortic surgery as well as after surgery for critical limb ischemia. A picture starts to form of which predisposing factors lead to increased risk of delirium. The leading risk factors consistently identified in this systematic review were advanced age and cognitive impairment. Multi-disciplinary specialist-led interventions in the preoperative phase could decrease incidence and severity of delirium and should be focused on identified high-risk patients.
术后谵妄是老年患者常见且严重的不良事件，与显著的发病率和死亡率相关。识别发生谵妄的高危患者，以便集中采取预防策略非常重要。本文的目的是系统回顾血管外科术后谵妄的现有术前危险因素的相关文献。
使用 PubMed 和 EMBASE 进行系统文献检索，使用 MeSH 术语和关键词“谵妄”、“手术”和“危险因素”。在符合严格纳入标准的情况下，保留研究进行综述，纳入标准包括仅评估择期血管手术患者谵妄危险因素的前瞻性研究。需要使用《精神障碍诊断与统计手册》（DSM）或《国际疾病分类》第 10 版（ICD-10）来确诊谵妄。
纳入了 15 篇文章，研究中的谵妄发生率在 5%至 39%之间。许多因素与谵妄风险增加相关，包括年龄、认知障碍、合并症、抑郁、吸烟、酗酒、视力和听力障碍、ASA 评分、生化异常、手术策略和失血。
老年患者择期血管手术后发生谵妄较为常见。在开放性主动脉手术以及治疗严重肢体缺血的手术后，谵妄发生率最高。越来越多的诱发因素导致发生谵妄的风险增加。在这个系统综述中一致确定的主要危险因素是高龄和认知障碍。在术前阶段进行多学科专家主导的干预措施可能会降低谵妄的发生率和严重程度，应针对确定的高危患者进行干预。
