Dyer C B, Ashton C M, Teasdale T A
Section of Geriatrics, Houston (Tex) Veterans Affairs Medical Center.
Arch Intern Med. 1995 Mar 13;155(5):461-5. doi: 10.1001/archinte.155.5.461.
We conducted an on-line search and manual searches for 1966 through 1992 to determine the incidence, diagnosis, risk factors, and treatment of postoperative delirium. Of the 374 citations found, 277 articles were excluded after criteria of relevance were applied. After methodologic criteria for validity were applied to the remaining 80 articles, 26 studies were retained for the final information synthesis. The incidence of postoperative delirium was 36.8% (range, 0% to 73.5%). Primary reasons for this disparity were insufficient sample size and inconsistent application of numerous diagnostic tools. One study provided statistically significant data that demonstrated that postoperative delirium is underdiagnosed by physicians and nurses. Four of the articles that met the established criteria provided risk factor data. Although age, preoperative cognitive impairment, and the use of anticholinergic drugs were significantly associated with postoperative delirium, gender, type and route of anesthesia, and sleep deprivation were not. Two studies demonstrated a decreased incidence of postoperative delirium when patients underwent preoperative psychiatric counseling or participated in a structured perioperative program. These findings indicate a need for (1) accurate incidence data with further definition of risk factors and (2) studies that address the diagnosis and treatment of this common postoperative problem.
我们进行了一项在线搜索，并对1966年至1992年期间的文献进行了手工检索，以确定术后谵妄的发生率、诊断、危险因素及治疗方法。在检索到的374篇文献中，应用相关性标准后排除了277篇文章。对其余80篇文章应用有效性的方法学标准后，保留了26项研究用于最终的信息综合分析。术后谵妄的发生率为36.8%（范围为0%至73.5%）。造成这种差异的主要原因是样本量不足以及众多诊断工具的应用不一致。一项研究提供了具有统计学意义的数据，表明医生和护士对术后谵妄的诊断不足。符合既定标准的4篇文章提供了危险因素数据。虽然年龄、术前认知障碍和抗胆碱能药物的使用与术后谵妄显著相关，但性别、麻醉类型和途径以及睡眠剥夺与之无关。两项研究表明，当患者接受术前心理咨询或参与结构化的围手术期项目时，术后谵妄的发生率会降低。这些发现表明需要（1）有准确的发生率数据并进一步明确危险因素，（2）开展针对这一常见术后问题的诊断和治疗的研究。
