术后谵妄患者心脏手术后视觉材料投射的双盲随机临床试验。
Projection of visual material on postoperative delirium in patients undergoing cardiac surgery: A double blind randomized clinical trial.
机构信息
Health Research Nursing Group (GREIS), University of León, León, Spain.
University Hospital of León, León, Spain.
出版信息
Medicine (Baltimore). 2024 Oct 4;103(40):e39470. doi: 10.1097/MD.0000000000039470.
BACKGROUND
Postoperative delirium is a neurobehavioral disorder that can appear after surgery. It is characterized by an altered level of consciousness and impaired cognitive function. The aim of this study was to evaluate the impact of visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period, and its influence on the incidence and development of postoperative delirium.
METHODS
A randomized, double-blind clinical trial was designed in the immediate postoperative period of adult patients undergoing cardiac surgery. Consolidated Statement of Reporting Trials guidelines were followed. A control group (CG) and an intervention group (IG) were established. In the IG, the patients underwent a visual projection, while the usual unit treatment was carried out with the CG. Sociodemographic, anthropometric, anesthetic, and surgical variables were also recorded. The postoperative delirium assessment scale used was the confusion assessment method for diagnosing delirium in intensive care unit patients.
RESULTS
Information was collected from 104 patients undergoing cardiac surgery. Most of the patients included in the study were men (66.35%) and the most performed surgical intervention was aortic valve replacement (34.62%). In the CG, positive patients in postoperative delirium increased from 19.23% to 25%, while in the IG they decreased from 5.77% to 1.92%. The logistic regression analysis presents a prediction model where the variables that influence the model are gender and group membership, meaning that being female and belonging to the IG significantly reduce the presence of delirium.
CONCLUSION
The projection of visual material reduced the incidence of postoperative delirium in patients undergoing cardiac surgery, although it cannot be established that it is effective as a treatment once the pathology is already established.
背景
术后谵妄是一种手术后可能出现的神经行为障碍。其特征为意识水平改变和认知功能受损。本研究旨在评估在心脏手术后即刻期为患者投射亲属或爱人的图像对术后谵妄发生率和发展的影响。
方法
设计了一项在心脏手术后成年患者即刻期的随机、双盲临床试验。遵循了 CONSORT 声明报告试验指南。设立了对照组（CG）和干预组（IG）。在 IG 中，患者接受了视觉投射，而 CG 则进行常规单位治疗。还记录了社会人口统计学、人体测量学、麻醉和手术变量。使用的术后谵妄评估量表是 ICU 患者诊断谵妄的意识混乱评估方法。
结果
从 104 例接受心脏手术的患者中收集了信息。研究中纳入的大多数患者为男性（66.35%），最常进行的手术干预是主动脉瓣置换术（34.62%）。在 CG 中，术后谵妄阳性患者从 19.23%增加到 25%，而在 IG 中从 5.77%减少到 1.92%。逻辑回归分析呈现出一个预测模型，其中影响模型的变量是性别和组别的成员身份，这意味着女性和属于 IG 显著降低了谵妄的发生。
结论
在心脏手术后患者中，投射视觉材料可降低术后谵妄的发生率，尽管不能确定其在病理已经确立时作为治疗的有效性。
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