Lim Tae Sung, Lee Jin Soo, Yoon Jung Han, Moon So Young, Joo In Soo, Huh Kyoon, Hong Ji Man
Department of Neurology, School of Medicine, Ajou University, 5 San, Woncheon-dong, Yongtong-gu, Suwon-si, Kyunggi-do, 442-749, Republic of Korea.
BMC Neurol. 2017 Mar 23;17(1):56. doi: 10.1186/s12883-017-0840-3.
Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke.
A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge.
Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P < .001), exhibited poorer functional performance at discharge and 3 months after discharge, and stayed in hospital significantly longer. Independent risk factors for delirium were older age, history of cigarette smoking, and major hemispheric stroke.
Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.
卒中后谵妄是卒中患者护理中常见的问题，与住院时间延长、短期高死亡率以及长期护理需求增加有关。尽管约10%~30%的患者会发生卒中后谵妄，但对于急性卒中患者发生卒中后谵妄的危险因素知之甚少。
在一家三级转诊医院的急性卒中护理单元，对576例连续发生缺血性卒中的患者（平均年龄65.2岁；范围23~93岁）进行了为期2年的谵妄筛查。我们使用意识错乱评估法筛查谵妄。一旦怀疑有谵妄，我们使用韩国版的谵妄评定量表修订版98评估症状。入院和出院时使用美国国立卫生研究院卒中量表评估神经功能缺损，出院时和出院后3个月使用巴氏指数和改良Rankin量表评估功能能力。
38例（6.7%）卒中患者在入住急性卒中护理单元期间发生谵妄。与未发生谵妄的患者相比；发生谵妄的患者年龄显著更大（70.6岁对64.9岁，P=0.001），吸烟频率更高（40%对24%，P=0.033）。在临床特征方面，谵妄组发生大脑半球主要卒中的比例显著更高（55%对26%，P<0.001），出院时和出院后3个月的功能表现更差，住院时间显著更长。谵妄的独立危险因素是年龄较大、吸烟史和大脑半球主要卒中。
突然戒烟可能是缺血性卒中患者发生卒中后谵妄的危险因素。卒中后谵妄的发生与更差的预后和更长的住院时间有关。
