Sano Kuninori, Watanabe Aki, Kawaguchi Takayuki, Sakamoto Yasunori, Fukuda Michinari
Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan.
Department of Rehabilitation, Kanagawa University of Human Services, Yokosuka, Japan.
Prog Rehabil Med. 2024 Aug 21;9:20240026. doi: 10.2490/prm.20240026. eCollection 2024.
Occupational therapy (OT) studies of delirium have attempted to test the effectiveness of interventions to reduce the incidence and duration of delirium. Although some cognitive stimulation appears to be important, appropriate approaches to delirium characterized by cognitive dysfunction remain unclear. This study aimed to determine the incidence and duration of delirium in postoperative cardiovascular surgery patients at the initial time of OT to identify characteristics of patient demographics and cognitive function according to the presence or absence of delirium.
This retrospective study included patients judged to have delirium by the Confusion Assessment Method at the first postoperative OT session (after extubation) in the intensive care unit (ICU). Patient data included age, sex, days until extubation, type of hospitalization, outcome at discharge, Sequential Organ Failure Assessment score and Glasgow Coma Scale (GCS) score at the first OT session, presence or absence of delirium, duration of delirium, and Mini-Mental State Examination-Japanese (MMSE-J) score. The Mann-Whitney U test was used to test differences between the delirium and the non-delirium groups, and a binomial generalized linear model (logistic regression model) with Bayesian estimation was adopted to investigate factors characterizing delirium.
A Bayesian logistic regression model with delirium as the dependent variable and "days until extubation" and "spatial orientation" as adjustment variables suggested that "spatial orientation" was a significant factor in delirium.
For ICU patients with delirium, the provision of information tailored toward spatial orientation during the first day of OT may improve delirium.
关于谵妄的职业治疗（OT）研究试图测试干预措施对降低谵妄发生率和持续时间的有效性。尽管一些认知刺激似乎很重要，但针对以认知功能障碍为特征的谵妄的适当方法仍不明确。本研究旨在确定术后心血管手术患者在首次接受职业治疗时谵妄的发生率和持续时间，以根据谵妄的有无确定患者人口统计学特征和认知功能特点。
这项回顾性研究纳入了在重症监护病房（ICU）术后首次职业治疗（拔管后）时通过混乱评估方法判定为谵妄的患者。患者数据包括年龄、性别、拔管天数、住院类型、出院结局、首次职业治疗时的序贯器官衰竭评估评分和格拉斯哥昏迷量表（GCS）评分、谵妄的有无、谵妄持续时间以及简易精神状态检查表 - 日本版（MMSE - J）评分。采用曼 - 惠特尼U检验来检验谵妄组和非谵妄组之间的差异，并采用具有贝叶斯估计的二项式广义线性模型（逻辑回归模型）来研究谵妄的特征因素。
以谵妄为因变量、“拔管天数”和“空间定向”为调整变量的贝叶斯逻辑回归模型表明，“空间定向”是谵妄的一个重要因素。
对于ICU中患有谵妄的患者，在职业治疗的第一天提供针对空间定向的信息可能会改善谵妄。
