外科重症老年非心脏手术患者术后谵妄的发生率及危险因素分析

摘要

Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery. Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit (SICU)after non-cardiac surgery were involved in the present study. Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit (CAM-ICU). Delirium assessment was performed once daily during the first five days after surgery. Results Postoperative evaluations of delirium were completed in 124 patients. Postoperative delirium occurred in 42 patients (33.87％), among them delirium occurred within the first 2 postoperative days in 92.86％(39/42) (4.76％ in the operative day, 50.00％ in the first postoperative day, and 38.10％ in the second postoperative day,respectively). When compared with the non-delirious patients, the delirious patients had longer duration of ICU stay [39.75 (21.00-65.63)h vs 19.63 (17.77-22.31)h., P=0.000], higher incidence of postoperative complications [(38. 1％(16/42) vs 13.4％ (11/82), P =0.000], and higher mortality [11.9％(5/42) vs 1.2％(1/82), P=0.000]. Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident ( OR=3.051, 95％CI 1.032-8.370), high APACHE Ⅱ score at admission to the SICU ( OR=1.664, 95％ CI 1.268-2.184), and high pain score at 24 hours after operation (OR=1.043,95％ CI 1.021 - 1.086). Conclusions Delirium is a common complication after surgery. The prognosis is significantly worse in the delirious patients than in the non-delirious patients. Risk factors of postoperative delirium include history of preoperative cerebral accident. high APACHE Ⅱ score at admission to the SICU, and high pain score at 24 hours after operation.%目的 研究外科重症老年非心脏手术患者术后谵妄的发生率,分析其危险因素.方法 选择2009年6月-2009年12月非心脏手术后入外科重症监护室(SICU)的125例老年患者,记录术前基本资料和围术期相关变量.采用ICU谵妄诊断的意识状态评估法(CAM-ICU)评估患者是否发生谵妄,于术后5d内每天评估1次.分析患者术后发生谵妄的危险因素.结果 124例患者完成了术后谵妄评估.术后共有42例患者(33.87%)发生谵妄,其中92.86%(39/42)的患者在术后2d内发生谵妄[分别为手术当天2例(4.76%),术后第1天21例(50.00%),术后第2天16例(38.10%)].与非谵妄患者相比,谵妄患者术后的SICU内停留时间更长[19.63(17.77～22.31)h vs 39.75(21.00～65.63)h,P=0.000],且谵妄患者术后并发症发生率和死亡率[分别为38.1%(16/42)、11.9%(5/42)]高于非谵妄患者[分别为13.4%(11/82)、1.2%(1/82),P=0.000].Logistic回归分析显示发生术后谵妄的危险因素包括术前脑卒中史(OR=3.051.95%CI 1.032～8.370)、入SICU时APACHE Ⅱ评分高(OR=1.664,95%CI 1.268～2.184)、术后24h疼痛评分高(QR=1.043,95%CI 1.021～I.086).结论 谵妄是手术后常见的并发症,而且谵妄的发生常伴随患者预后的恶化.术前脑卒中史、入SICU时APACHE Ⅱ评分高、术后24h疼痛评分高是导致外科重症老年患者发生术后谵妄的独立危险因素.