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卒中后患者谵妄与院前用药之间的关联

Association between Delirium and Prehospitalization Medication in Poststroke Patients.

作者信息

Hosoya Ryuichiro, Sato Yohei, Ishida Emika, Shibamoto Haruna, Hino Seiichi, Yokote Hiroaki, Kamata Tomoyuki

机构信息

Department of Pharmacy, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan; Department of Clinical Pharmaceutics, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan.

Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan.

出版信息

J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1914-1920. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.038. Epub 2018 Mar 27.

Abstract

PURPOSE

Medication is an important risk factor for delirium; however, the association between delirium and prehospitalization medication is unclear. We investigated the association between prestroke medication and poststroke delirium.

MATERIALS AND METHODS

All patients hospitalized in the stroke care unit from September 2011 to September 2012 were selected, and their delirium symptoms, patient information, and pre- and poststroke medications were analyzed. Delirium was defined as a score of  4 or higher on the Intensive Care Delirium Screening Checklist. Factors that were related to delirium were extracted using univariate analysis, and the independent risk factors were determined using multivariate analysis.

RESULTS

Of the 269 patients analyzed, 97 (36%) experienced delirium. Univariate analysis revealed significant differences between the delirium and nondelirium groups in age, dementia, previous cerebrovascular disease, craniotomy, all insertion-tube types, and 6 categories of prestroke medication. Prestroke polypharmacy was associated with poststroke delirium (P = .002). Multivariate analysis showed that taking antianxiety agents or sleep aids was an independent risk factor for delirium (odds ratio: 3.17, 95% confidence interval: 1.16-8.82).

CONCLUSIONS

The present study suggests that prestroke medication affects the onset of poststroke delirium. These findings can contribute to the prediction and prevention of this condition.

摘要

目的

药物治疗是谵妄的一个重要风险因素;然而,谵妄与院前用药之间的关联尚不清楚。我们调查了卒中前用药与卒中后谵妄之间的关联。

材料与方法

选取2011年9月至2012年9月在卒中护理单元住院的所有患者,分析他们的谵妄症状、患者信息以及卒中前后的用药情况。谵妄定义为重症监护谵妄筛查清单得分4分及以上。采用单因素分析提取与谵妄相关的因素,采用多因素分析确定独立危险因素。

结果

在分析的269例患者中,97例(36%)发生谵妄。单因素分析显示,谵妄组与非谵妄组在年龄、痴呆、既往脑血管疾病、开颅手术、所有插管类型以及6类卒中前用药方面存在显著差异。卒中前多种药物联合使用与卒中后谵妄相关(P = 0.002)。多因素分析表明,服用抗焦虑药或助眠药是谵妄的独立危险因素(比值比:3.17,95%置信区间:1.16 - 8.82)。

结论

本研究表明,卒中前用药会影响卒中后谵妄的发生。这些发现有助于对这种情况进行预测和预防。

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