Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.
Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Canada.
J Thorac Cardiovasc Surg. 2018 Feb;155(2):660-667.e2. doi: 10.1016/j.jtcvs.2017.09.131. Epub 2017 Oct 20.
Delirium is a common neurologic complication after cardiac surgery. Our primary objective was to determine the impact of delirium on self-reported problems with midterm cognitive functioning and mood postcardiac surgery.
A single-center, prospective cohort study was conducted, enrolling 197 patients undergoing coronary artery bypass grafting or valve replacement. Baseline cognition and mood were assessed preoperatively in elective patients as a part of routine care using the Montreal Cognitive Assessment and Patient Health Questionnaire 9, respectively. During hospitalization, delirium was diagnosed using the Confusion Assessment Method (Confusion Assessment Method/Confusion Assessment Method Intensive Care Unit). Follow-up assessments were carried out via telephone interview at 6 to 9 months after cardiac surgery using the EuroQoL-5D, Patient Health Questionnaire 9, Alcohol Use Disorders Identification Test Consumption, Memory Impairment Screen, and Category Fluency Test assessments. We examined resultant scores in the domains of cognition and mood among delirious and nondelirious cohorts, controlling for confounders deemed clinically relevant.
A total of 197 patients were enrolled in the study, of whom 44 (22%) developed postoperative delirium. After adjustment, no differences were observed in cognitive functioning between the delirious and nondelirious subjects after 6 to 9 months. However, delirious patients were more likely to experience self-reported problems in affective (depression and anxiety) functioning as measured by the EuroQoL-5D (odds ratio, 4.41; 95% confidence interval, 1.51-12.92; P < .01).
Postoperative delirium is associated with increased anxiety and depression at 6 to 9 months postcardiac surgery. Future investigation should seek to evaluate the utility of screening programs for affective disorders in those individuals who develop delirium in the postoperative period.
谵妄是心脏手术后常见的神经系统并发症。我们的主要目的是确定术后谵妄对中期认知功能和情绪的自我报告问题的影响。
进行了一项单中心前瞻性队列研究，纳入 197 例行冠状动脉旁路移植术或瓣膜置换术的患者。择期患者在术前作为常规护理的一部分，使用蒙特利尔认知评估和患者健康问卷 9 分别评估基线认知和情绪。在住院期间，使用意识混乱评估方法（意识混乱评估方法/意识混乱评估方法重症监护病房）诊断谵妄。心脏手术后 6 至 9 个月通过电话访谈进行随访评估，使用欧洲五维健康量表、患者健康问卷 9、酒精使用障碍识别测试消耗、记忆障碍筛查和类别流畅性测试评估。我们检查了谵妄和非谵妄队列中认知和情绪领域的结果评分，控制了被认为具有临床意义的混杂因素。
共纳入 197 例患者，其中 44 例（22%）发生术后谵妄。调整后，6 至 9 个月后，谵妄组和非谵妄组在认知功能方面无差异。然而，与非谵妄组相比，谵妄组在情感（抑郁和焦虑）功能方面自我报告的问题更常见，这是通过欧洲五维健康量表（优势比，4.41；95%置信区间，1.51-12.92；P <.01）测量的。
术后谵妄与心脏手术后 6 至 9 个月时的焦虑和抑郁增加有关。未来的研究应该评估在术后期间发生谵妄的个体中筛查情感障碍的筛查计划的效用。
