危重患者术后谵妄对远期生存率的影响

摘要

Objective To identify the influence of early postoperative delirium on long-term morbidity ,mortality and quality of life(QoL) .Methods 261 patients admitting to SICU after noncardiac surgery were prospectively included .The clinical data were collected .Delirium was diagnosed clinically by Confusion Assessment Method-Intensive Care Unit(CAM-ICU) .The patients were followed 2 years after the surgery and the quality of life was assessed by three scales .Results The incidence of early PD was 21 .8% .Multivariate logistic regression analysis showed that increasing age ,shorter educational time ,preoperative diabetes melli-tus ,high ASA grades and high APACHE II score on SICU admission were the independent predictors for early PD .The cumulative survival in 24 months was 66 .5% in patients without delirium and 57 .3% in patients with delirium ,there was no statistical differ-ence between two groups(P=0 .187) .Multivariable Cox model showed that male patients ,tumor stage ≥3 and high ASA grades were the independent predictors for postoperative death .The long-term QoL in delirious patients were significant poorer than that in non-delirious patients in mainly four domains :physical function ,role-physical ,social function and cognitive function .Conclusion Early postoperative delirium significantly deteriorate the long-term quality of life in severe patient after noncardiac surgery in mainly four domains :physical function ,role-physical ,social function and cognitive function .%目的：探讨术后早期谵妄对患者远期生存质量、并发症发生率及病死率的影响。方法本研究为前瞻性的临床观察队列研究。261例行非心脏大手术、术后送入SICU且年龄大于65岁的患者入选本研究。收集患者的一般资料并记录围术期情况，采用CAM-ICU表对患者进行术后早期谵妄评估。手术2年后对患者进行随访，了解其健康状况，并用SF-36等量表评价患者的生存质量。结果术后谵妄的发生率为21．8％。多因素Logistic回归分析显示年龄增加、受教育时间短、术前糖尿病病史、术前的ASA分级高和送入SICU时APACHEⅡ评分高等是术后早期谵妄的独立危险因素。手术后平均随访时间为（21．4±5．3）个月。术后24个月时谵妄患者的累积生存率为57．3％，而未谵妄患者为66．5％，差异无统计学意义（P＝0．187）。COX风险比例模型多因素分析显示，男性患者、恶性肿瘤分期大于或等于3期患者、术前ASA分级高是术后死亡的独立危险因素。谵妄患者术后远期的生理功能、生理职能和社会功能以及认知能力明显低于非谵妄患者。结论危重患者非心脏手术后的早期谵妄对患者的远期生存质量有显著的不良影响，主要体现在影响患者的认知功能、生理功能、生理职能和社会功能。