Ten Broeke Miarca, Koster Sandra, Konings Thomas, Hensens Ab G, van der Palen Job
1 Department of Cardiothoracic Surgery, Medisch Spectrum Twente, The Netherlands.
2 Department of Medical School Twente, The Netherlands.
Eur J Cardiovasc Nurs. 2018 Mar;17(3):255-261. doi: 10.1177/1474515117733365. Epub 2017 Oct 5.
Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery.
The aim of this study was to validate the risk model for delirium and further improve the risk model.
A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium.
Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73-0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73-0.85; P<0.001).
The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.
谵妄是一种常见的临时性精神障碍，常发生于接受心脏手术的患者。术前识别高危患者以预防谵妄的负面副作用很重要。科斯特及其同事设计了一个风险模型，以识别心脏手术后发生术后谵妄风险增加的患者。
本研究的目的是验证谵妄风险模型并进一步改进该风险模型。
在对329例患者进行术前门诊筛查时，使用了包含与术后谵妄相关预测因素的谵妄风险检查表。术前和术后使用谵妄观察筛查量表评估谵妄。
与科斯特及其同事的模型相比，年龄大于70岁和有谵妄病史被确认为术后谵妄的统计学显著预测因素，而认知障碍和酒精滥用几乎是显著因素。欧洲心脏手术风险评估系统（EuroSCORE）、合并症和手术类型不能再次预测术后谵妄。该模型的曲线下面积为0.79（95%置信区间（CI）0.73 - 0.86；P<0.001）。基于本研究的数据，该模型通过以下术后谵妄的独立预测因素得到改进：年龄、一种以上合并症、谵妄病史和较低的标准化简易精神状态检查评分，曲线下面积为0.79（95%CI 0.73 - 0.85；P<0.001）。
该风险模型无法得到充分验证。随着时间的推移很难验证一个风险模型；存在不同的情况，比如对谵妄预防的关注度增加。
