Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2022 Feb;51(2):87-95. doi: 10.47102/annals-acadmedsg.2021297.
Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery.
Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC).
Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, =0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, =0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, =0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, =0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, =0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
麻醉后监护病房（PACU）谵妄是一种潜在可预防的病症，可导致长期的严重后果。在一项多中心前瞻性队列研究中，我们调查了在新加坡 4 家主要医院接受非心脏大手术的老年患者术后谵妄的发生率和危险因素。
从新加坡 4 家主要医院征得同意并招募患者。获得了研究伦理批准。纳入年龄>65 岁、行>2 小时非心脏手术的患者。收集围手术期基线数据。获得术前基线认知。患者在 PACU 苏醒后 30-60 分钟使用护理谵妄筛查量表（Nu-DESC）评估谵妄。
98 例患者完成了研究。11 例（11.2%）患者发生术后谵妄。发生 PACU 谵妄的患者年龄更大（74.6±3.2 岁 vs 70.6±4.4 岁，=0.005）。单因素分析显示，发生 PACU 谵妄的患者更有可能为 ASA 3 级（63.6% vs 31.0%，=0.019）、估算肾小球滤过率（eGFR）>60mL/min/1.73m2（36.4% vs 10.6%，=0.013）、糖化血红蛋白（HbA1C）值较高（7.8±1.2 vs 6.6±0.9，=0.011）、随机血糖升高（10.0±5.0mmol/L vs 6.5±2.4mmol/L，=0.0066）、有中重度抑郁（18.2% vs 1.1%，P=0.033）。他们更有可能在医院停留更长时间（中位数 8 天[范围 4-18] vs 4 天[范围 2-8]，P=0.049）。多元分析显示，随机血糖升高与 PACU 谵妄的发生独立相关。
