神经外科重症监护病房中颅脑损伤手术后谵妄的危险因素。
Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit.
作者信息
Chen Ri-Yu, Zhong Chang-Hui, Chen Wei, Lin Ming, Feng Chang-Fu, Chen Chang-Neng
机构信息
Radiology Department Intervention Room, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, Hainan Province, China.
Department of Critical Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, Hainan Province, China.
出版信息
World J Clin Cases. 2022 Jul 26;10(21):7341-7347. doi: 10.12998/wjcc.v10.i21.7341.
BACKGROUND
Postoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury. However, there is no specific medical test to predict postoperative delirium to date.
AIM
To explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit (ICU).
METHODS
A retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People's Hospital/Hainan Hospital Affiliated to Hainan Medical University, The First Affiliated Hospital of Hainan Medical University, and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020. The patients were categorized into groups based on whether delirium occurred. Of them, 25 patients with delirium were included in the delirium group, and 95 patients without delirium were included in the observation group. Logistic regression analysis was used to explore the association between sex, age, educational level, Glasgow coma scale (GCS), complications (with or without concussion, cerebral contusion, hypoxemia and ventricular compression) and site of injury and delirium.
RESULTS
The GCS score above 8 and concomitant disease of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit (ICU) (all < 0.05). However, age, sex, administration more than three medicines, and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU ( < 0.05). Multivariate logistic regression analysis showed that GCS score above 8, cerebral concussion, cerebral contusion, hypoxemia, ventricle compression, and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU ( < 0.05).
CONCLUSION
GCS score, concussive concussion, cerebral contusion, hypoxemia, ventricle compression, and damage to frontal lobe are risk factors of postoperative delirium.
背景
颅脑损伤患者接受神经外科手术后，术后谵妄很常见。然而，迄今为止尚无特异性医学检查来预测术后谵妄。
目的
探讨神经外科重症监护病房（ICU）中颅脑损伤患者术后谵妄的危险因素。
方法
对2018年1月至2020年1月期间入住海南人民医院/海南医学院附属海南医院、海南医学院第一附属医院和海南医学院第二附属医院的120例颅脑损伤患者进行回顾性分析。根据是否发生谵妄将患者分组。其中，25例发生谵妄的患者纳入谵妄组，95例未发生谵妄的患者纳入观察组。采用Logistic回归分析探讨性别、年龄、教育程度、格拉斯哥昏迷量表（GCS）、并发症（有无脑震荡、脑挫裂伤、低氧血症和脑室受压）及损伤部位与谵妄之间的关联。
结果
入住神经外科重症监护病房（ICU）的患者中，GCS评分高于8分、伴有脑震荡、脑挫裂伤、低氧血症和脑室受压以及额叶损伤与谵妄相关（均P<0.05）。然而，年龄、性别、使用三种以上药物及教育程度与神经外科ICU中颅脑损伤患者谵妄的发生无显著关联（P>0.05）。多因素Logistic回归分析显示，GCS评分高于8分、脑震荡、脑挫裂伤、低氧血症、脑室受压及额叶病变是神经外科ICU中颅脑损伤患者谵妄的独立危险因素（P<0.05）。
结论
GCS评分、脑震荡、脑挫裂伤、低氧血症、脑室受压及额叶损伤是术后谵妄的危险因素。
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