Hori Yukio, Mihashi Mutsuko
Kurume University Graduate School of Medicine, Kurume 830-0003, Japan and.
Kurume University School of Medicine, Nursing, Kurume 830-0003, Japan.
Yonago Acta Med. 2023 Apr 21;66(2):214-222. doi: 10.33160/yam.2023.05.003. eCollection 2023 May.
Delirium is a clinical symptom that can have serious side effects in patients, and it develops acutely and shows reversibility. Postoperative delirium is an important neuropsychological complication after surgery that directly or indirectly affects patients.
Cardiac surgery increases the risk of delirium due to the complexity of surgical procedures, use of intraoperative and postoperative anesthetics and other pharmacologic agents, and possible postoperative complications. This study aims to determine the relationship between the development of delirium and its causative factors after cardiac surgery and its associated postoperative complications, and identify the high-relevance risk factors of postoperative delirium.
The participants comprised 730 patients who were admitted to the intensive care unit and underwent cardiac surgery. The collected data included 19 risk factors based on the patients' medical information records. As a delirium diagnostic tool, we used the Intensive Care Delirium Screening Checklist, with four or more points indicating delirium. For statistical analysis, the dependent variables were determined based on the presence or absence of delirium, while the independent variables were determined based on the risk factors of delirium. A -test, χ test, and logistic regression analysis were performed on risk factors between the two groups-the delirium group and no delirium group.
Postoperative delirium was observed in 126 (17.3%) of 730 patients after cardiac surgery. Postoperative complications were more common in the delirium group. Independent risk factors associated with postoperative delirium were identified in 7 of the 12 factors.
As cardiac surgery is invasive and affects the development and severity of delirium, efforts and intervention methods are necessary to predict the risk factors for the development of delirium before surgery, and to prevent its occurrence after surgery. In the future, it is necessary to further investigate factors associated with delirium that can be directly intervened.
谵妄是一种可对患者产生严重副作用的临床症状，其起病急且具有可逆性。术后谵妄是手术后一种重要的神经心理并发症，会直接或间接影响患者。
由于手术操作复杂、术中及术后使用麻醉药和其他药物以及可能出现的术后并发症，心脏手术会增加谵妄风险。本研究旨在确定心脏手术后谵妄的发生与病因及其相关术后并发症之间的关系，并识别术后谵妄的高度相关危险因素。
研究对象包括730例入住重症监护病房并接受心脏手术的患者。收集的数据包括基于患者医疗信息记录的19个危险因素。作为谵妄诊断工具，我们使用了重症监护谵妄筛查清单，四分及以上表明存在谵妄。进行统计分析时，因变量根据谵妄的有无确定，自变量根据谵妄的危险因素确定。对谵妄组和无谵妄组两组之间的危险因素进行t检验、χ检验和逻辑回归分析。
730例心脏手术后患者中有126例（17.3%）出现术后谵妄。术后并发症在谵妄组中更为常见。在12个因素中的7个因素中确定了与术后谵妄相关的独立危险因素。
由于心脏手术具有侵入性且会影响谵妄的发生和严重程度，因此有必要在手术前努力预测谵妄发生的危险因素并采取干预措施，以防止术后谵妄的发生。未来，有必要进一步研究可直接干预的与谵妄相关的因素。
