上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 12: 1580 - 1586

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.12.006

临床护理专题

ICU老年患者术后谵妄发生的特征及影响因素分析

  • 吴志山 ,
  • 黄润 ,
  • 梁丽萍 ,
  • 朱宇婷 ,
  • 郑乔木 ,
  • 姜丽萍
展开
  • 1.上海交通大学护理学院，上海 200025
    2.上海交通大学医学院附属新华医院心胸外科，上海 200092
    3.上海交通大学医学院附属新华医院老年科，上海 200092
    4.上海交通大学医学院附属新华医院护理部，上海 200092
吴志山（1994—），男，硕士生；电子信箱：zhishan0110@163.com。
姜丽萍，电子信箱：13868311990@163.com。

收稿日期: 2020-12-18

  网络出版日期: 2021-01-28

基金资助

上海交通大学护理高原学科建设项目(Hlgy1801sjk)

收起

Characteristics and influencing factors of postoperative delirium among elderly patients in intensive care unit

  • Zhi-shan WU ,
  • Run HUANG ,
  • Li-ping LIANG ,
  • Yu-ting ZHU ,
  • Qiao-mu ZHENG ,
  • Li-ping JIANG
Expand
  • 1.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
    2.Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    3.Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    4.Department of Nursing, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
JIANG Li-ping, E-mail: 13868311990@163.com.

Received date: 2020-12-18

  Online published: 2021-01-28

Supported by

Shanghai Jiao Tong University Nursing Discipline Construction Project(Hlgy1801sjk)

Fold

摘要

目的·了解重症监护病房（intensive care unit，ICU）老年患者术后谵妄发生的特征并分析其影响因素。方法·采用方便抽样法，选取2020年5月—9月入住上海交通大学医学院附属新华医院心胸外科ICU的老年术后患者作为研究对象。采用ICU意识模糊评估量表（Confusion Assessment Method-ICU，CAM-ICU）对患者进行谵妄评估。从患者手术结束转入ICU后开始评估，至术后第7日或转出ICU停止评估，记录患者谵妄发生情况。收集患者人口学及临床相关资料，并采用单因素分析和Logistic多因素回归分析探讨ICU老年患者术后谵妄的影响因素。结果·共纳入343例患者，103例发生术后谵妄，发生率为30.03%。谵妄发生时间在手术结束后7.5~130.0 h，平均为（47.4±29.7）h，中位数为35.5（23.0，61.0）h。谵妄发生在全天各时间段内分布均匀，仅术后24 h内谵妄昼夜发生时间存在集中趋势，高发时间为上午11：53，其他时间发生的谵妄昼夜分布无显著集中趋势。谵妄持续时间为6.5~131.0 h，平均为（32.4±28.1）h，中位数为20.5（14.0，45.0）h。单因素分析显示，谵妄组和无谵妄组患者的性别、糖尿病史、心功能分级、美国麻醉医师协会 （American Society of Anesthesiologists，ASA）麻醉分级、术中资料（手术时长、出血量、体外循环、低血压）、术后资料（机械通气、氧合指数）等差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，ASA分级、术中低血压、术中体外循环对ICU老年患者术后谵妄有显著影响（均P<0.05）。结论·ICU老年患者术后谵妄发生率高，ASA分级高、术中低血压及术中体外循环是术后谵妄发生的影响因素。医护人员应了解其发生的特征及影响因素，加强谵妄评估并及时实施防治措施，以降低谵妄发生率、缩短谵妄持续时间。

关键词： 术后谵妄; 重症监护病房; 老年人; 特征分析; 影响因素

本文引用格式

吴志山 , 黄润 , 梁丽萍 , 朱宇婷 , 郑乔木 , 姜丽萍 . ICU老年患者术后谵妄发生的特征及影响因素分析[J]. 上海交通大学学报（医学版）, 2021 , 41(12) : 1580 -1586 . DOI: 10.3969/j.issn.1674-8115.2021.12.006

Abstract

Objective

·To investigate the characteristics and influencing factors of postoperative delirium among elderly patients admitted to intensive care unit (ICU).

Methods

·The convenience sampling method was used to select cardiothoracic surgical ICU patients after operation in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from May to September 2020. Delirium was assessed using the Confusion Assessment Method-ICU (CAM-ICU) and the assessment was performed until ICU discharge or for a maximum of 7 d, whichever occurred first. Patients′ demographics and clinical data were collected. The influencing factors were analyzed by univariate analysis and multivariate Logistic regression.

Results

·A total of 343 patients were included for this study and 103 developed postoperative delirium, with an incidence of 30.03%. All the delirium occurred within 7.5?130.0 h after operation, with a mean of (47.4±29.7) h and a median of 35.5(23.0, 61.0) h. On the whole, delirium uniformly distributed throughout the day. Only the delirium that occurred within 24 h after surgery showed a central tendency with the high-incidence time at 11:53 am while the others did not. Delirium duration lasted 6.5?131.0 h, with a mean of (32.4±28.1) h and a median of 20.5(14.0, 45.0) h. Comparison of the characteristics of patients in the delirium group and non-delirium group showed that there were statistical differences in gender, history of diabetes, heart function classification, American Society of Anesthesiologists (ASA) classification, operation duration, intraoperative blood loss, intraoperative cardiopulmonary bypass, intraoperative hypotension, postoperative mechanical ventilation and postoperative oxygenation index. Multivariate Logistic regression analysis showed that ASA classification, intraoperative hypotension and cardiopulmonary bypass had significant influence on postoperative delirium (all P<0.05).

Conclusion

·The incidence of postoperative delirium is high among elderly patients who are admitted in ICU after operation. Higher ASA classification, intraoperative hypotension and cardiopulmonary bypass are influencing factors of delirium. To reduce delirium occurrence and shorten its duration, medical staff should understand the characteristics and influencing factors of postoperative delirium, evaluate delirium and implement preventive interventions.

Key words： postoperative delirium; intensive care unit (ICU); the aged; characteristic analysis; influencing factor

参考文献

1 汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识[J]. 中华内科杂志, 2019, 58(2): 108-118.
2 Li X, Zhang LN, Gong F, et al. Incidence and risk factors for delirium in older patients following intensive care unit admission: a prospective observational study[J]. J Nurs Res, 2020, 28(4): e101.
3 Pavone KJ, Jablonski J, Junker P, et al. Evaluating delirium outcomes among older adults in the surgical intensive care unit[J]. Heart Lung, 2020, 49(5): 578-584.
4 Kirfel A, Menzenbach J, Guttenthaler V, et al. Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital[J]. Aging Clin Exp Res, 2021. DOI: 10.1007/s40520-021-01842-x.
5 Bryczkowski SB, Lopreiato MC, Yonclas PP, et al. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit[J]. J Trauma Acute Care Surg, 2014, 77(6): 944-951.
6 Gaete OD, Papathanassoglou E, Norris CM. The lived experience of delirium in intensive care unit patients: a meta-ethnography[J]. Aust Crit Care, 2020, 33(2): 193-202.
7 Day J, Higgins I. Existential absence: the lived experience of family members during their older loved one's delirium[J]. Qual Health Res, 2015, 25(12): 1700-1718.
8 潘燕彬, 颜建龙, 骆谏英, 等. 谵妄患者远期预后的研究进展[J]. 中华护理杂志, 2019, 54(9): 1415-1418.
9 Shi SM, Sung M, Afilalo J, et al. Delirium incidence and functional outcomes after transcatheter and surgical aortic valve replacement[J]. J Am Geriatr Soc, 2019, 67(7): 1393-1401.
10 张海涛, 唐远志, 秦颖. 60岁以上结直肠癌患者术后谵妄的危险因素和临床结局[J]. 中华胃肠外科杂志, 2017, 20(11): 1263-1268.
11 Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis[J]. BMJ, 2015, 350: h2538.
12 Bijker JB, van Klei WA, Kappen TH, et al. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection[J]. Anesthesiology, 2007, 107(2): 213-220.
13 Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710.
14 邹姮婧. 中文版CAM-ICU的信度效度检验及与其他量表的比较[D]. 武汉: 华中科技大学, 2012.
15 Velayati A, Vahdat SM, Shahbazi E, et al. Association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: a prospective cohort study[J]. Nutrition, 2019, 66: 227-232.
16 J?rvel? K, Porkkala H, Karlsson S, et al. Postoperative delirium in cardiac surgery patients[J]. J Cardiothorac Vasc Anesth, 2018, 32(4): 1597-1602.
17 张竞超, 张丁恺, 郭龙辉, 等. 心脏外科手术后谵妄的危险因素分析[J]. 中华胸心血管外科杂志, 2019, 35(1): 29-32.
18 Kochunov P, Ramage AE, Lancaster JL, et al. Loss of cerebral white matter structural integrity tracks the gray matter metabolic decline in normal aging[J]. Neuroimage, 2009, 45(1): 17-28.
19 Kelly KM, Nadon NL, Morrison JH, et al. The neurobiology of aging[J]. Epilepsy Res, 2006: 68(): S5-S20.
20 Juraska JM, Lowry NC. Neuroanatomical changes associated with cognitive aging[J]. Curr Top Behav Neurosci, 2012, 10: 137-162.
21 Kazmierski J, Banys A, Latek J, et al. Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study[J]. Crit Care, 2013, 17(2): R38.
22 Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure[J]. Int J Geriatr Psychiatry, 2018, 33(11): 1428-1457.
23 Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU[J]. Crit Care Med, 2018, 46(9): e825-e873.
24 中华医学会老年医学分会. 老年患者术后谵妄防治中国专家共识[J]. 中华老年医学杂志, 2016, 35(12): 1257-1262.
25 Lee H, Oh SY, Yu JH, et al. Risk factors of postoperative delirium in the intensive care unit after liver transplantation[J]. World J Surg, 2018, 42(9): 2992-2999.
26 Zhang W, Hu W, Shen M, et al. Profiles of delirium and the clinical outcomes of patients who underwent coronary artery bypass grafting: a prospective study from China[J]. J Clin Nurs, 2016, 25(5-6): 631-641.
27 Grover S, Kate N, Malhotra S, et al. Symptom profile of delirium in children and adolescent: does it differ from adults and elderly?[J]. Gen Hosp Psychiatry, 2012, 34(6): 626-632.
28 刘春雪, 章洁, 邢攸红, 等. 急性心肌梗死并发谵妄的发作特点及其护理[J]. 解放军护理杂志, 2010, 27(16): 1241-1242, 1245.
29 Bellelli G, Carnevali L, Corsi M, et al. The impact of psychomotor subtypes and duration of delirium on 6-month mortality in hip-fractured elderly patients[J]. Int J Geriatr Psychiatry, 2018, 33(9): 1229-1235.
30 Lee H, Ju JW, Oh SY, et al. Impact of timing and duration of postoperative delirium: a retrospective observational study[J]. Surgery, 2018, 164(1): 137-143.
31 Khan BA, Perkins AJ, Prasad NK, et al. Biomarkers of delirium duration and delirium severity in the ICU[J]. Crit Care Med, 2020, 48(3): 353-361.
32 Cereghetti C, Siegemund M, Schaedelin S, et al. Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: an observational cohort study[J]. J Cardiothorac Vasc Anesth, 2017, 31(6): 1966-1973.
33 Janssen TL, Steyerberg EW, Faes MC, et al. Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: a cohort study[J]. Int J Surg, 2019, 71: 29-35.
34 Oldroyd C, Scholz AFM, Hinchliffe RJ, et al. A systematic review and meta-analysis of factors for delirium in vascular surgical patients[J]. J Vasc Surg, 2017, 66(4): 1269-1279.e9.
35 Sankar A, Johnson SR, Beattie WS, et al. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice[J]. Br J Anaesth, 2014, 113(3): 424-432.
36 Giannice R, Foti E, Poerio A, et al. Perioperative morbidity and mortality in elderly gynecological oncological patients (≥70 years) by the American Society of Anesthesiologists physical status classes[J]. Ann Surg Oncol, 2004, 11(2): 219-225.
37 Siepe M, Pfeiffer T, Gieringer A, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium[J]. Eur J Cardiothorac Surg, 2011, 40(1): 200-207.
38 Maheshwari K, Ahuja S, Khanna AK, et al. Association between perioperative hypotension and delirium in postoperative critically ill patients: a retrospective cohort analysis[J]. Anesth Analg, 2020, 130(3): 636-643.
39 Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery[J]. Br J Anaesth, 2015, 115(3): 418-426.
40 Brady K, Hogue CW. Intraoperative hypotension and patient outcome: does "one size fit all?"[J]. Anesthesiology, 2013, 119(3): 495-497.
41 Siepe M, Pfeiffer T, Gieringer A, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium[J]. Eur J Cardiothorac Surg, 2011, 40(1): 200-207.
42 Burkhart CS, Rossi A, Dell-Kuster S, et al. Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation[J]. Br J Anaesth, 2011, 107(5): 742-748.
43 Shadvar K, Baastani F, Mahmoodpoor A, et al. Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU[J]. J Cardiovasc Thorac Res, 2013, 5(4): 157-161.
44 黄伟明, 周成斌. 体外循环新进展[M]. 北京: 人民卫生出版社, 2017.
45 Salameh A, Dhein S, D?hnert I, et al. Neuroprotective strategies during cardiac surgery with cardiopulmonary bypass[J]. Int J Mol Sci, 2016, 17(11): 1945.
46 Zakkar M, Guida G, Suleiman MS, et al. Cardiopulmonary bypass and oxidative stress[J]. Oxid Med Cell Longev, 2015, 2015: 189863.
Options
文章导航

/

〈 〉