接受静脉自控镇痛患者术后谵妄的发生率、危险因素及现象学特征：一项前瞻性队列研究
Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study.
作者信息
Lin Yao Tsung, Lan Kuo Mao, Wang Li-Kai, Chu Chin-Chen, Wu Su-Zhen, Chang Chia-Yu, Chen Jen-Yin
机构信息
Department of Anesthesiology.
Department of Neurology, Chi Mei Medical Center.
出版信息
Neuropsychiatr Dis Treat. 2016 Dec 13;12:3205-3212. doi: 10.2147/NDT.S119817. eCollection 2016.
BACKGROUND
Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited.
OBJECTIVE
We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA.
METHODS
A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0-10). Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS) (0-10). An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1) is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required.
RESULTS
In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, <0.001; day 2, 9.6% vs 2.0%, =0.028; day 3, 4.1% vs 2.1%, =0.412). However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9%) POD cases in IVPCA patients showed either one or two symptoms. The symptoms of POD were ranked from high to low as disorientation (65.7%), illusions/hallucinations (37.1%), inappropriate communication (31.4%), inappropriate behavior (25.7%), and psychomotor retardation (14.2%).
CONCLUSION
The incidence rate of POD in IVPCA patients was low. Further research is warranted concerning POD and IVPCA pain management.
背景
静脉自控镇痛（IVPCA）是缓解疼痛的常用方法，而疼痛是术后谵妄（POD）的一个危险因素。然而，关于IVPCA患者发生POD的研究有限。
目的
我们旨在确定接受IVPCA的患者中POD的发生率、危险因素和现象学特征。
方法
对年龄≥60岁的全身麻醉后接受IVPCA的患者进行一项前瞻性队列研究。采用护理谵妄筛查量表（NuDESC；0 - 10分）评估POD。术后3天内，急性疼痛服务团队每天两次检查谵妄、静息和/或活动时的疼痛严重程度以及IVPCA的副作用。疼痛严重程度采用11点言语数字评定量表（11点VNRS）（0 - 10分）进行测量。11点VNRS>3被认为疼痛缓解不充分。如果怀疑发生POD（通过NuDESC≥1检测到），则需要咨询神经科医生或精神科医生以确认疑似POD。
结果
共纳入1608例患者。POD的发生率为2.2%。年龄≥70岁和美国麻醉医师协会身体状况>III级是IVPCA患者发生POD的危险因素。所有POD病例中约四分之三发生在术后的前两天内。对于静息时的疼痛，疼痛缓解不充分的患者发生POD的比例显著高于疼痛缓解充分的患者（第1天，8.4%对1.5%，<0.001；第2天，9.6%对2.0%，=0.028；第3天，4.1%对2.1%，=0.412）。然而，POD的发生率与活动诱发的疼痛缓解无关。IVPCA患者中大多数（占79.9%）POD病例表现出一或两种症状。POD的症状从高到低依次为定向障碍（65.7%）、错觉/幻觉（37.1%）、言语不当（31.4%）、行为不当（25.7%）和精神运动迟缓（14.2%）。
结论
IVPCA患者中POD的发生率较低。关于POD和IVPCA疼痛管理需要进一步研究。
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