Objective:To investigate whether preoperative surgical intensive care unit (SICU) environment familiarization could decrease the incidence of postoperative delirium in elderly patients undergoing thoracic surgery.Methods:A total of 296 patients over 65 years old whom were expected to stay more than 3 days in SICU after elective thoracic surgery were selected.Informed consent was obtained in all patients,and they were randomly divided into environment familiarization group (EF group,n =147) and control group(n =149).The diagnosis of delirium was made according to confusion assessment method for the ICU (CAM-ICU).Serum cortisol concentration was measured at 1 d before operation,as well as at 24,48 and 72 h after operation in SICU by enzyme-linked immunosorbent assay.Postoperative recovery was evaluated by 40-item quality of recovery score (QoR40) after operation.Results:The incidence and duration of postoperative delirium in EF group were 15.65 ％ (23/147) and (35.20 ± 1.82)h,which were lower than those in control group[30.20 ％(45/149) and (73.23 ± 2.68)h](P＜0.05).Compared with the EF group[5 (3.40 ％)],there were more delirium patients in control group[1 5 (10.07 ％)] at 48 h after operation(P＜0.05).At 24,48 and 72 h after operation,serum cortisol concentrations in EF group were (614.03 ± 242.80),(442.87 ± 82.23) and(369.45 ± 84.42)nmol/L,which were lower than those in control group[(879.21 ± 154.43),(737.67 ± 148.90)and (641.13 ± 163.78)nmol/L] (P＜0.05).Serum cortisol concentrations in control group after operation were significant higher than that before operation[(404.19 ± 75.34)nmol/L].There was a significant increase(P＜0.05) at 24 h after operation in EF group compared with that before operation[(382.04 ± 13.38)nmol/L].QoR40 scores in EF group were (137.96 ±30.22) and (143.64 ± 29.34) at 24 and 48 h after operation,which were significantly higher(P＜0.05) than those in control group[(125.04 ± 28.33) and (129.44 ± 39.76)].The duration of SICU and hospital stay in EF group were (3.98 ± 0.99)d and (17.58 ± 10.73)d,respectively,which were significantly shorter(P＜0.05) than those in control group[(6.22 ± 3.94)d and (22.54 ± 13.21)d].Conclusions:Preoperative environment familiarization can reduce the incidence and duration of postoperative delirium in elderly patients undergoing thoracic surgery and improve the quality of postoperative recovery.%目的:探讨术前熟悉外科重症监护室(surgical intensive care unit,SICU)环境能否降低胸外科老年患者术后谵妄的发生率.方法:选择65岁以上择期行胸外科手术且预期术后进入SICU 3 d以上并签署知情同意书的患者296例.根据随机数字表法分成术前SICU环境熟悉组(EF组,n=147)和对照组(n=149),采用ICU意识混乱评价法(confusion assessment method for the ICU,CAM-ICU)进行谵妄评估,采用酶联免疫吸附法测定术前1d以及术后24、48和72 h患者血清皮质醇浓度.采用40项恢复质量评分(40-item quality of recovery score,QoR40)评估术后恢复情况.结果:EF组术后谵妄发生率及持续时间分别为15.65 ％(23/147)、(35.20±1.82)h,均低于对照组[30.20 ％(45/149)、(73.23±2.68)h],P＜0.05；其中EF组术后48 h谵妄人数5例,占3.40％,低于对照组[15例(10.07％)],P＜0.05.EF组术后24、48和72 h皮质醇浓度分别为(614.03±242.80)、(442.87±82.23)、(369.45±84.42) nmol/L,均低于对照组(879.21±154.43)、(737.67±148.90)、(641.13±163.78)nmol/L]P＜0.05;对照组术后各时间段皮质醇浓度均高于术前[(404.19±75.34) nmol/L],P＜0.05;EF组仅术后24 h皮质醇浓度与术前[(382.04±13.38)nmol/L]比较差异有统计学意义(P＜0.05).EF组术后24和48 hQoR40评分分别为(137.96±30.22)、(143.64±29.34),均高于对照组[(125.04±28.33)、(129.44±39.76)]P＜0.05;在SICU时间和住院时间分别为(3.98±0.99)d、(17.58±10.73)d,均少于对照组[(6.22±3.94)d、(22.54±13.21)d]P＜0.05.结论:术前熟悉SICU环境能减少胸外科老年患者术后谵妄的发生率及持续时间,还可改善老年患者术后恢复质量.
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