Shirvani Fahimeh, Naji Seyed Ali, Davari Elham, Sedighi Mohsen
Department of Nursing and Midwifery, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
Asian Cardiovasc Thorac Ann. 2020 Nov;28(9):566-571. doi: 10.1177/0218492320947230. Epub 2020 Aug 5.
Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting.
This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed.
Patients in the control group used cigarettes (31.1% vs. 11.1%, = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, = 0.020), and fewer blood components infused (15.6% vs. 33.3%, = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, = 0.001). Multivariable analysis showed significant associations between Neecham score and age ( = 0.022), ejection fraction ( = 0.015), myocardial infarction ( = 0.016), systolic pressure ( = 0.009), and diastolic pressure ( = 0.008).
Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.
术后谵妄在接受冠状动脉旁路移植术的患者中很常见，其特征为认知功能下降。本研究旨在评估早期计划性活动对冠状动脉旁路移植术后谵妄的影响。
这项双盲随机临床试验纳入了2018年9月至12月连续接受冠状动脉旁路移植术的92例患者。患者被分为两组，每组46例：干预组在术后前两天应用活动方案；对照组仅接受常规护理。分析了人口统计学数据、病历和尼查姆混乱评分。
对照组患者更频繁地使用香烟（31.1%对11.1%，P = 0.020）和罂粟用于消遣（35.6%对8.9%，P = 0.002），插管时间更长（11.91±3.87对10.23±2.71小时，P = 0.020），输注的血液成分更少（15.6%对33.3%，P = 0.05）。与对照组相比，干预组更多患者在术后第2天功能正常（分别为25例对2例，P = 0.001）。干预组在术后第2天的尼查姆评分显著更高（22.49±2.03对26.82±2.10，P = 0.001）。多变量分析显示尼查姆评分与年龄（P = 0.022）、射血分数（P = 0.015）、心肌梗死（P = 0.016）、收缩压（P = 0.009）和舒张压（P = 0.008）之间存在显著关联。
早期计划性活动对降低接受冠状动脉旁路移植术患者的术后谵妄有效。
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