协和医学杂志

2011, v.2(04) 319-325

[打印本页] [关闭]
本期目录(Current Issue) | 过刊浏览(Past Issue) | 高级检索(Advanced Search)

老年非心脏手术患者术后谵妄的流行病学调查
Epidemiological Survey on Postoperative Delirium in Elderly Noncardiac Surgical Patients

谭刚;郭向阳;罗爱伦;黄宇光;徐建青;
TAN Gang1,GUO Xiang-yang2,LUO Ai-lun1,HUANG Yu-guang1,XU Jian-qing1 1Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2Department of Anesthesiology,Third Hospital of Peking University,Beijing 100191,China

摘要(Abstract):

目的探讨老年非心脏手术患者术后谵妄的发病情况,分析谵妄发病围手术期危险因素。方法采用整群抽样调查方法,计算预计样本量为712例。选择2006年8月至12月北京协和医院65岁以上全麻或区域麻醉下行择期非心脏手术普通病房住院患者,术前1d及术后1、2、3d密切随访患者,谵妄诊断标准参照美国精神病学会制订的意识错乱评估方法(confusion assessment method,CAM)。按设计调查表详细记录术前病史、合并症,术中麻醉方式、麻醉用药,术中、术后并发症,术后镇痛等各项内容,建立数据库。所有数据用SAS8.2软件进行统计分析。结果共718例患者纳入研究,其中80例术后发生谵妄,发病率为11.1%;80例谵妄患者中68例(85%)为一过性谵妄(<24h),另12例(15%)持续性谵妄患者中8例为术后转重症监护病房(intensive care unit,ICU)需呼吸支持治疗的患者。多因素Logistic逐步回归分析结果表明高龄(OR:1.480,95%CI:1.070~2.046)、脑血管意外病史(OR:2.862,95%CI:1.432~5.720)、东莨菪碱(OR:2.537,95%CI:1.523~4.227)、哌替啶(OR:3.196,95%CI:1.574~6.488)、术中低血压(OR:1.780,95%CI:1.070~2.960)、手术时间超过3h(OR:2.610,95%CI:1.538~4.431)、术后转入ICU(OR:2.187,95%CI:1.077~4.442)等为术后谵妄的危险因素。结论高龄、既往脑血管意外病史患者是术后谵妄的易感人群,围手术期尽量避免低血压的发生、减少东莨菪碱及哌替啶的使用,缩短手术时间可能会降低谵妄的发生率。
Objective To investigate the incidence of delirium after noncardiac surgery among elderly patients and explore the possible perioperative risk factors.Methods In this cross-sectional study using cluster sampling,totally 718 patients aged 65 or older who had undergone elective noncardiac surgeries in our hospital from August to December 2006 were enrolled.Patients were interviewed at the day before surgery and an informed consent was obtained.The same interviewer evaluated the patients prospectively for delirium with the Confusion Assessment Method(CAM) on the preoperative day 1,postoperative day 1,day 2,and day 3.Other information including previous medical history,comorbidities,anesthetics,and perioperative medications were also recorded.Results Delirium occurred in 80 patients(11.1%) at during the first three postoperative days,among whom transient symptoms were more frequent than continuous delirium status(68,85% vs.12,15%).The Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age(OR:1.480,95%CI:1.070-2.046),history of stroke(OR:2.862,95%CI:1.432-5.720),use of meperidine(OR:3.196,95%CI:1.574-6.488) or scopolamine(OR:2.537,95% CI:1.523-4.227),hypotention during the operation(OR:1.780,95%CI:1.070-2.960),long-duration operations(≥3 h)(OR:2.610,95%CI:1.538-4.431),and ICU admission after surgeries(OR:2.187,95%CI:1.077-4.442).Conclusions Advanced age or previous history of stroke are the most important risk factors of postoperative delirium.The incidence of postoperative delirium may be decreased by avoiding other risk factors such as perioperative hypotension,usage of meperidine and scopolamine,and long-duration operation.

关键词(KeyWords): 谵妄;麻醉;手术;发病率;危险因素
delirium;anesthesia;surgery;incidence rate;risk factors

Abstract:

Keywords:

基金项目(Foundation): 人事部、教育部归国人员启动基金;; 北京协和医院基金

作者(Author): 谭刚;郭向阳;罗爱伦;黄宇光;徐建青;
TAN Gang1,GUO Xiang-yang2,LUO Ai-lun1,HUANG Yu-guang1,XU Jian-qing1 1Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China 2Department of Anesthesiology,Third Hospital of Peking University,Beijing 100191,China

Email:

DOI:

参考文献(References):

扩展功能
本文信息
服务与反馈
本文关键词相关文章
本文作者相关文章
中国知网
分享