Sauvigny Thomas, Mohme Malte, Grensemann Jörn, Dührsen Lasse, Regelsberger Jan, Kluge Stefan, Schmidt Nils Ole, Westphal Manfred, Czorlich Patrick
Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Neurosurg Rev. 2019 Jun;42(2):481-488. doi: 10.1007/s10143-018-0990-9. Epub 2018 Jun 9.
Hyperactive delirium (agitation) is a common complication in patients on intensive care units and can be assessed by the Richmond Agitation and Sedation Scale (RASS) in principle. However, the role of agitation in patients with aneurysmal subarachnoid haemorrhage (SAH) is poorly understood. We performed a retrospective analysis to identify risk factors for the development of a hyperactive delirium and its functional consequences for neurological outcome. Three hundred thirty-eight patients with SAH were screened in this study resulting in 212 patients which reached at least once a RASS of 0 and were eligible for further analysis. Clinical characteristics were analysed towards the occurrence of a hyperactive delirium. Neurological outcome at discharge and follow-up was assessed using the Glasgow Outcome Scale. Seventy-eight of 212 patients (36.8%) developed a hyperactive delirium; the duration ranged from 1 to 11 days. Multivariate regression revealed initial hydrocephalus (odds ratio (OR) 3.21 95% confidence interval (CI) [1.33-7.70]; p = 0.01), microsurgical clipping (OR 3.70 95%CI 1.71-8.01]; p = 0.001), male gender (OR 1.97 95%CI [1.05-3.85]; p = 0.047) and a higher Graeb score (OR 1.11 95%CI [1.00-1.22]; p = 0.043) to be significantly associated with the development of agitation. Medical history of psychiatric disorders, alcohol or nicotine abuse showed no correlation with agitation. Cox regression analysis revealed no significant influence of agitation towards unfavourable outcome at discharge or follow-up. We provide four independent risk factors for the development of agitation in SAH patients. Our study emphasizes the specific entity of agitation in patients with SAH and underscores its relevance in neurological patients.
躁动性谵妄（激越）是重症监护病房患者常见的并发症，原则上可通过里士满躁动镇静量表（RASS）进行评估。然而，人们对激越在动脉瘤性蛛网膜下腔出血（SAH）患者中的作用了解甚少。我们进行了一项回顾性分析，以确定发生躁动性谵妄的危险因素及其对神经功能预后的影响。本研究筛查了338例SAH患者，最终纳入212例至少有一次RASS评分为0且符合进一步分析条件的患者。分析了与躁动性谵妄发生相关的临床特征。出院时及随访时的神经功能预后采用格拉斯哥预后量表进行评估。212例患者中有78例（36.8%）发生了躁动性谵妄；持续时间为1至11天。多因素回归分析显示，初始脑积水（比值比（OR）3.21，95%置信区间（CI）[1.33 - 7.70]；p = 0.01）、显微手术夹闭（OR 3.70，95%CI [1.71 - 8.01]；p = 0.001）、男性（OR 1.97，95%CI [1.05 - 3.85]；p = 0.047）以及较高的格雷布评分（OR 1.11，95%CI [1.00 - 1.22]；p = 0.043）与激越的发生显著相关。精神疾病史、酒精或尼古丁滥用与激越无相关性。Cox回归分析显示，激越对出院时或随访时不良预后无显著影响。我们提供了SAH患者发生激越的四个独立危险因素。我们的研究强调了SAH患者激越这一特定情况，并突出了其在神经科患者中的相关性。
