Yajima Shugo, Nakanishi Yasukazu, Ogasawara Ryo Andy, Imasato Naoki, Hirose Kohei, Katsumura Sao, Kataoka Madoka, Masuda Hitoshi
National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
Eur J Surg Oncol. 2024 Apr;50(4):108243. doi: 10.1016/j.ejso.2024.108243. Epub 2024 Mar 3.
This study compared the clinical characteristics of patients who had hallucinations and those who did not during delirium after elective cancer surgery.
This study retrospectively observed 1137 consecutive patients who had preoperative screening by a trained nurse before elective major urologic cancer surgery in our department. We compared the patient characteristics, including mini-cognitive assessment instrument (Mini-Cog) and Geriatric-8 (G8) scores, between those who developed postoperative delirium and those who did not, and also between those who had hallucinations and those who did not during delirium.
Out of 1137 patients, 68 developed postoperative delirium, and 12 of them had hallucinations. A hierarchical cluster analysis based on the G8 and Mini-Cog scores divided the patients into two groups: one with high G8 and cognitive function (36 patients) and one with low G8 and cognitive function (32 patients). Hallucinations during delirium were more frequent in the high G8 and cognitive function group (11 out of 36 patients) than in the low G8 and cognitive function group (one out of 32 patients). Patients who had hallucinations during delirium also had higher preoperative Mini-Cog scores (P = 0.002) and G8 scores (P = 0.03) than those who did not, indicating better cognitive function and less frailty.
We identified a patient population that is prone to hallucinations that preoperative screening tools cannot detect. This suggests the heterogeneity of postoperative delirium and the need for further research.
本研究比较了择期癌症手术后谵妄期间出现幻觉的患者与未出现幻觉的患者的临床特征。
本研究回顾性观察了在我院泌尿外科择期进行大型癌症手术前由训练有素的护士进行术前筛查的1137例连续患者。我们比较了术后发生谵妄的患者与未发生谵妄的患者之间的患者特征，包括简易认知评估工具（Mini-Cog）和老年8项（G8）评分，以及谵妄期间出现幻觉的患者与未出现幻觉的患者之间的患者特征。
在1137例患者中，68例发生了术后谵妄，其中12例出现了幻觉。基于G8和Mini-Cog评分的分层聚类分析将患者分为两组：一组G8和认知功能较高（36例患者），另一组G8和认知功能较低（32例患者）。谵妄期间出现幻觉在G8和认知功能较高的组（36例患者中有11例）比在G8和认知功能较低的组（32例患者中有1例）更常见。谵妄期间出现幻觉的患者术前Mini-Cog评分（P = 0.002）和G8评分（P = 0.03）也高于未出现幻觉的患者，表明认知功能更好且虚弱程度更低。
我们确定了一组易出现幻觉的患者群体，而术前筛查工具无法检测到。这表明术后谵妄的异质性以及进一步研究的必要性。
