术前护士主导的定向计划对心血管手术后术后谵妄的影响：一项回顾性单中心观察性研究。
The impact of a preoperative nurse-led orientation program on postoperative delirium after cardiovascular surgery: a retrospective single-center observational study.
作者信息
Nakamura Ryo, Miyamoto Kyohei, Tsuji Kaori, Ozaki Kana, Kunimoto Hideki, Honda Kentaro, Nishimura Yoshiharu, Kato Seiya
机构信息
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
出版信息
J Intensive Care. 2023 May 17;11(1):20. doi: 10.1186/s40560-023-00666-3.
BACKGROUND
Postoperative delirium in intensive care is common and associated with mortality, cognitive impairment, prolonged hospital stays and high costs. We evaluate whether a nurse-led orientation program could reduce the incidence of delirium in the intensive care unit after cardiovascular surgery.
METHODS
In this retrospective cohort study, we enrolled patients admitted to the intensive care unit for planned cardiovascular surgery between January 2020 and December 2021. A nurse-led orientation program based on a preoperative visit was routinely introduced from January 2021. We assessed the association between these visits and postoperative delirium in the intensive care unit. We also assessed predictors of postoperative delirium with baseline and intraoperative characteristics.
RESULTS
Among 253 patients with planned cardiovascular surgery, 128 (50.6%) received preoperative visits. Valve surgery comprised 44.7%, coronary surgery 31.6%, and aortic surgery 20.9%. Cardiopulmonary bypass use and transcatheter surgery were 60.5% and 12.3%, respectively. Incidence of delirium was lower in patients that received preoperative visits, and median hospital stay was shorter than in those without visits (18 patients [14.1%] vs 34 patients [27.2%], P < 0.01; 14 days vs 17 days, P < 0.01). After adjusting predefined confounders, preoperative visits were independently associated with decreased incidence of delirium (adjusted odds ratio [aOR] 0.45; 95% confidence interval [95% CI] 0.22-0.84). Other predictors of delirium were higher European System for Cardiac Operative Risk Evaluation II score and lower minimum intraoperative cerebral oxygen saturation.
CONCLUSIONS
A preoperative nurse-led orientation program was associated with reduction of postoperative delirium and could be effective against postoperative delirium after cardiovascular surgery. Trial registration UMIN Clinical Trial Registry no. UMIN000048142. Registered 22, July, 2022, retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000054862 .
背景
重症监护病房中的术后谵妄很常见，且与死亡率、认知障碍、住院时间延长和高成本相关。我们评估了由护士主导的定向计划是否可以降低心血管手术后重症监护病房中谵妄的发生率。
方法
在这项回顾性队列研究中，我们纳入了2020年1月至2021年12月期间因计划进行心血管手术而入住重症监护病房的患者。从2021年1月开始常规引入基于术前访视的由护士主导的定向计划。我们评估了这些访视与重症监护病房中术后谵妄之间的关联。我们还根据基线和术中特征评估了术后谵妄的预测因素。
结果
在253例计划进行心血管手术的患者中，128例（50.6%）接受了术前访视。瓣膜手术占44.7%，冠状动脉手术占31.6%，主动脉手术占20.9%。体外循环的使用率和经导管手术率分别为60.5%和12.3%。接受术前访视的患者谵妄发生率较低，且中位住院时间比未接受访视的患者短（18例[14.1%]对34例[27.2%]，P<0.01；14天对17天，P<0.01）。在调整了预定义的混杂因素后，术前访视与谵妄发生率降低独立相关（调整后的优势比[aOR]为0.45；95%置信区间[95%CI]为0.22-0.84）。谵妄的其他预测因素是欧洲心脏手术风险评估系统II评分较高和术中最低脑氧饱和度较低。
结论
术前由护士主导的定向计划与术后谵妄的减少相关，并且可能对心血管手术后的术后谵妄有效。试验注册日本大学医学情报网临床试验注册编号。UMIN000048142。于2022年7月22日注册，追溯注册，https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000054862 。
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