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【原】【罌粟摘要】術(shù)后譫妄是影響老年患者在重癥監(jiān)護病房和醫(yī)院住院時間長短的獨立因素

罌粟花anesthGH 2022-06-20 發(fā)布于貴州

展開全文

術(shù)后譫妄是影響老年患者在重癥監(jiān)護病房和醫(yī)院住院時間長短的獨立因素

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：安麗編輯：張中偉審校：曹瑩

背景

術(shù)后譫妄(POD)是一中不常被發(fā)現(xiàn)的老年人術(shù)后不良事件。通過適當(dāng)篩查(PROPDESC)試驗對70歲及以上患者進(jìn)行術(shù)前預(yù)測術(shù)后譫妄的亞組分析，目的是確定術(shù)前危險因素以及POD對ICU和醫(yī)院住院時間(LOS)的影響。

方法

在2018年9月至2019年10月德國的一大學(xué)醫(yī)院招募了1097名患者，通過PROPDESC試驗篩查對其行前瞻性觀察研究，其中588名年齡在70歲及以上的患者(平均年齡77.2 4.7歲)被納入亞組分析。如果在術(shù)后5個隨訪天數(shù)中，下列任何一項試驗陽性，則認(rèn)為POD陽性:ICU的混淆評估方法（CAM-ICU），混淆評估方法（CAM）、4'A（4AT）和譫妄觀察量表（DOS）。由接受過培訓(xùn)的醫(yī)生進(jìn)行上述探訪，此外，為了完成DOS，對護理人員對患者進(jìn)行了相關(guān)情況了解。采用多變量線性回歸分析方法，探討POD對ICU和住院患者住院時間的獨立影響。

結(jié)果

POD發(fā)病率為25.9%。我們的篩查結(jié)果顯示POD是ICU患者（36%；95%可信區(qū)間4-78%；<0.001）和醫(yī)院住院患者（22%；95%可信區(qū)間4-43%；<0.001）。

結(jié)論：POD對ICU和住院患者的住院時間有獨立影響。根據(jù)POD對老年人的影響，需要進(jìn)行標(biāo)準(zhǔn)化的風(fēng)險篩查。

原始文獻(xiàn)來源:

Andrea Kirfel, Vera Guttenthaler,Andreas Mayr, Mark Coburn,JanMenzenbach, MariaWittmann.Postoperative delirium is an independent factor infuencing the length of stay of elderly patients in the intensive care unit and in hospital.Journal of Anesthesia https:///10.1007/s00540-022-03049-4

英文原文：

Postoperative delirium is an independent factor infuencing the length of stay of elderly patients in the intensive care unit and in hospital

Abstract

Purpose Postoperative delirium (POD) is an often unrecognized adverse event in older people after surgery. The aim of this subgroup analysis of the PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) trial in patients aged 70 years and older was to identify preoperative risk factors and the impact of POD on length of stay (LOS) in intensive care unit (ICU) and hospital.

Methods Of the total 1097 patients recruited at a German university hospital (from September 2018 to October 2019) in the PROPDESC prospective observational study, 588 patients aged 70 years and older (mean age 77.2±4.7 years) were included for subgroup analysis. The primary endpoint POD was considered positive if one of the following tests were positive on any of the fve postoperative visit days: Confusion Assessment Method for ICU (CAM-ICU), Confusion Assessment Method (CAM), 4'A's (4AT) and Delirium Observation Scale (DOS). Trained doctoral students carried out these visitations and additionally the nursing staf were interviewed for completion of the DOS. To evaluate the independent efect of POD on LOS in ICU and in hospital, a multi-variable linear regression analysis was performed.

Results The POD incidence was 25.9%. The results of our model showed POD as an independent predictor for a prolonged LOS in ICU (36%; 95% CI 4–78%;<0.001) and in hospital (22%; 95% CI 4–43%;<0.001).

Conclusion POD has an independent impact on LOS in ICU and in hospital. Based on the efect of POD for the elderly, a standardized risk screening is required.