全麻苏醒期谵妄与S100β、NSE 的关系研究

目的:观察全麻患者苏醒期谵妄(Emergency Delirium,ED)与血浆S100β、NSE的关系.方法:选取84例择期全麻患者病人,于术前一天和术后苏醒期采用CAM量表进行谵妄状态评定,术后发生谵妄的患者为谵妄组,未发生谵妄的患者为对照组.并分别于术前、苏醒期,随机选择谵妄组42例,对照组42例抽取血清用ELASA方法测定S100β、NSE值.结果:血清S100β蛋白、NSE值在苏醒期谵妄患者和非谵妄组患者间差异无统计学意义(P＞0.05).结论:血清S100β蛋白、血清NSE与苏醒期谵妄发生无明显相关性.     

Carga anticolinérgica y delirium en pacientes mayores durante la hospitalización en una unidad de agudos de geriatría

BackgroundThe use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium.MethodsAn ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital. All patients over 80 years-old were included, except re-admissions or those subjected to palliative care. The data collected included sex, age, chronic medication and any recent changes, recent drugs prescribed prior to an episode of delirium, chronic kidney disease, diabetes mellitus, dementia, visual and auditory impairment, and their combination as sensory impairment, previous falls, stroke, brain tumour, and incident and prevalent delirium.ResultsA total of 72 patients were included. Incident delirium was detected in 8.1% of the patients, and prevalent delirium in 40.9%. A statistically significant association was established between anticholinergic drugs and the incident delirium measured by the ARS scale (P=.017). None of the scales was able to establish a significant association with prevalent delirium.ConclusionThe ARS scale was related to new episodes of delirium. All scales were insufficient when it came to establishing an association with prevalent delirium.     

A systematic review of multifactorial interventions for primary prevention of delirium in the elderly

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly patients in a general hospital. Primary prevention is important to prevent delirium. This article reviews recent developments with regard to multifactorial intervention trials for primary prevention of delirium. The review process involved a systematic search in MEDLINE, The Cochrane Database and CINAHL Database and subsequent examination of reference lists. Six studies were selected. Four studies showed that systemic interventions regarding medical-, nurse-led, environmental-, and educational items, were effective in preventing delirium. In one study a reduction was found in duration and severity of duration only. One study showed no effect on delirium at all. Despite the methodological weaknesses of the studies, conclusions are that different kinds of non-pharmacological interventions can be effective in preventing delirium.     

Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

Background

Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery.

Methods

We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality.

Results

We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%).Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality.

Conclusion

Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery.     

Delirium y delirium subsindrómico: prevalencia de un espectro de enfermedad

Introduction

Subsyndromal delirium (SSD) is a developing concept of disease with a spectrum beyond the diagnostic dichotomy of delirium with standard criteria.

Material and methods

To study the prevalence and significance of SSD we have conducted a cross-sectional prospective multicenter study of all patients admitted to three Geriatric Departments in tertiary hospitals. The SSD diagnostic criteria used were based on Marcantoniós criteria, and the DRS-R-98 scale was also used as a continuous variable of the degree of delirium.

Results

We studied 85 patients, 56% women, Barthel 62 (SD: 32), age 87 (SD: 6), CIRS-G 24 (SD: 6.85). Three quarters (75.3%) of patients had at least one CAM positive item, and half of them with at least 13 points in the DRS-R-98 scale. The prevalence of delirium was 53% and 22.3% for SSD. The degree of delirium-DSS was associated with different geriatric syndromes, levels of malnutrition, and degree of functional and cognitive impairment, with a significant linear trend between groups. Patients without delirium have higher levels than those with subsyndromal delirium, and these in turn are higher than those without diagnosed delirium. There is also a tendency in the degree of delirium measured by the DRS-R-98.

Conclusion

Beyond the dichotomous concept of the presence or absence of delirium, this study suggests the probable continuity of cognitive processes and the possibility of more effective and earlier diagnostic and therapeutic measures     

Different MMSE Score Is Associated with Postoperative Delirium in Young-Old and Old-Old Adults

BackgroundPostoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown.MethodsWe therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium.ResultsThirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively.ConclusionThe data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent.     

血清NSE、LP-PLA2联合CAR对老年股骨粗隆间骨折患者PFNA内固定术后谵妄的预测价值

摘要 目的：探讨血清神经元特异性烯醇化酶（NSE）、脂蛋白相关磷脂酶A2（LP-PLA2）联合C-反应蛋白与白蛋白比值（CAR）对老年股骨粗隆间骨折患者闭合复位防旋髓内钉（PFNA）内固定术后谵妄的预测价值。方法：选择2020年4月至2023年2月北京中医药大学第三附属医院收治的209例老年股骨粗隆间骨折患者。所有患者均行PFNA内固定术治疗，术前检测血清NSE、LP-PLA2、CAR，术后根据是否发生谵妄分为谵妄组和非谵妄组。多因素Logistic回归分析术后谵妄的因素。受试者工作特征（ROC）曲线分析NSE、LP-PLA2、CAR预测术后谵妄的价值。结果：术后43例发生谵妄，发生率为20.57%。谵妄组血清NSE、LP-PLA2、CAR高于非谵妄组（P＜0.05）。多因素Logistic回归分析显示年龄偏大、手术时间过长、高NSE、高LP-PLA2、高CAR是老年股骨粗隆间骨折患者术后谵妄的危险因素（P＜0.05）。NSE、LP-PLA2、CAR预测老年股骨粗隆间骨折患者术后谵妄的曲线下面积（AUC）为0.784、0.808、0.820，联合预测的AUC 为0.907，高于单独预测。结论：老年股骨粗隆间骨折PENA术后谵妄患者血清NSE、LP-PLA2、CAR增高，高水平NSE、LP-PLA2、CAR是术后谵妄的主要危险因素。联合NSE、LP-PLA2、CAR对术后谵妄风险有较高预测价值。     

Het electroencefalogram bij delier bij dementie (DBD)

Recognizing delirium superimposed on pre-existing cognitive impairment or dementia, ‘delirium superimposed on dementia’ (DSD), is challenging because signs of delirium might be interpreted as symptoms of pre-existing cognitive dysfunction.In this paper, we review the literature on the role of electrencephalography (EEG) in the differential diagnosis of delirium, dementia and DSD.Conventional EEG, applying twenty to thirty electrodes, taking thirty minutes registration, is not feasible in psychogeriatric patients. Recent studies suggest that it is possible to reliably detect delirium using only a limited number of EEG electrodes for a short period of time.With this, use of EEG in the detection of delirium in patients with cognitive impairment or clinically manifest dementia could be possible.     

术前糖化血红蛋白水平与老年髋关节置换术后谵妄的关系研究

摘要 目的：探讨术前糖化血红蛋白（HbAlc）水平与老年髋关节置换术后谵妄的关系,并分析术后发生谵妄的影响因素。方法：选择我院于2019年4月~2020年6月期间收治的行髋关节置换术的220例老年患者作为研究对象。收集患者临床资料,记录其术后发生谵妄情况。采用单因素及多因素Logistic回归分析术后发生谵妄的影响因素。采用Pearson相关分析评估患者术前HbAlc水平与术后意识障碍评估量表（CAM）评分的相关性。结果：220例患者根据剔除标准剔除20例,最终200例老年髋关节置换术后患者出现谵妄42例,发生率为21.00%（42/200）。将发生谵妄的患者纳为谵妄组（n=42）,未发生谵妄的患者纳为非谵妄组（n=158）。谵妄组的术前HbAlc水平、术后CAM评分均高于非谵妄组（P<0.05）。Pearson相关分析显示,患者术前HbAlc水平与术后CAM评分呈正相关（P<0.05）。单因素分析结果显示,老年髋关节置换术后发生谵妄与年龄、术前合并呼吸系统性疾病、手术时间、发生低氧血症、术后疼痛评分、存在电解质紊乱有关（P<0.05）,多因素Logistic回归分析结果显示,年龄>80岁、发生低氧血症、术后疼痛评分＞3分、术前HbAlc水平＞8%均是老年髋关节置换术后发生谵妄的危险因素（P<0.05）。结论：高龄、术前HbAlc水平较高的患者是髋关节置换术后发生谵妄的高危人群,且围术期应尽量给予减少疼痛、预防术后低氧血症的措施,以降低术后谵妄的发生风险。     

Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients

ABSTRACT

Postoperative delirium, a common perioperative complication, is frequently observed in elderly surgical patients. Few studies have investigated the life rhythm of preoperative patients, and whether or not the preoperative life rhythm is associated with the development of postoperative delirium. The purpose of this study was to investigate the relationship between the preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients. A total of 43 patients who underwent cardiovascular surgery were included in this prospective study between July 2016 and September 2017 at Kobe University Hospital. All subjects used a “Life Microscope” wristband (a wristwatch-type terminal incorporating a 3-axis accelerometer monitoring) for 3–7 days at home before the planned surgery. Hourly mean values were calculated for the metabolic equivalents from the obtained activity amounts, and subsequently evaluated using cosine periodic regression analysis. The circadian rhythm parameters of mesor (24 h time series mean), amplitude (half the peak-trough variation), and acrophase (peak time) for the metabolic equivalents were obtained. The intensive care delirium screening checklist was used to assess for postoperative delirium. The acrophase significantly advanced in the postoperative delirium group (median, 11:55 h [interquartile range, 11:06–12:27 h]) compared to the group without postoperative delirium (median, 13:25 h [interquartile range, 12:52–14:13 h]) (p < .001). Furthermore, binary logistic regression analysis showed that advances in the physical activity phase remained independently associated with postoperative delirium (odds ratio, 0.003 [95% confidence interval, 0–0.63]). These results suggest that misalignment between advanced life rhythm before hospitalization and life rhythm after hospitalization might be associated with risk for developing postoperative delirium. Our results led us to speculate that adequate consideration of the patient’s life rhythm before hospitalization is needed to prevent postoperative delirium.     

Hospital costs associated with delirium in older medical patients

Introduction

Delirium is a common and serious complication in older patients, associated with increased, potentially preventable, morbidity and mortality. The aim of this study was to evaluate the associated costs of delirium during hospitalization in a university affiliated hospital in Chile.

Materials and methods

Prospective cohort study of consecutive patients 65 years and older, admitted to a medical ward. A psychogeriatric team assessed patients during the first and every 48 h until discharge using the Confusion Assessment Method (CAM-S), length of hospital stay, pharmacy and total hospitalization costs were analyzed. Statistical analysis was performed using bivariate and multivariate analysis according to delirium diagnosis.

Results

Data from 454 patients was analyzed, 160 of them in a delirium cohort (35.2%) and 294 in a non-delirium cohort (64.8%). The delirium cohort had a longer hospital stay (DATA) and higher mortality (7.0% versus 1.7%). The median of total costs of delirium during hospital stay was 38.7% higher than the non-delirium cohort (P < .001). Total costs were significantly higher in the delirium cohort after adjustment of covariables (P = .01).

Conclusions

This study confirms that delirium is associated with significantly greater costs. Considering that effective delirium prevention is possible, the knowledge of associated costs can help health care providers to justify prevention strategies and finally give better care for older patients.     

Opvattingen van artsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium

To assess the current opinions of physicians and nurses regarding the prevention, diagnosis and management of delirium, survey administration was conducted to 2256 nurses and 982 physicians within the University Hospitals of Leuven (Belgium). Response rate was 26% with 819 respondents (600 nurses; 219 physicians) completing the questionnaire. 72% of the respondents considered delirium as a minor problem or no problem at all. Yet over half of respondents working on a palliative care unit (87%, n=15), traumatological ward (67%, n=18), cardio-thoracic surgery ward (58%, n=20), intensive care unit (55%, n=120) and geriatric ward (55%, n=42) reported it as a serious problem. Delirium was considered as an underdiagnosed (85%) but preventable (75%) syndrome. Yet patients at risk are rarely (34%) or never (52%) screened for delirium. In case of screening (48%), only 4% used a specific validated assessment tool. 97% of all respondents were convinced that delirium requires an active and immediate intervention of nurse and physician. 82% of the physicians preferred haldol to treat delirium, in case of alcohol withdrawal 69% chose tranxene. Physical restraints were considered important in the management of delirium by a greater proportion of nurses (49%) than physicians (28%). The severity of the problem is underestimated. While opinions regarding the treatment were quite correct, prevention and early detection of delirium deserve more attention.     

Klinik, Diagnostik und Therapie des nicht entzugsbedingten Delirs

Delirium due to a general medical condition is one of the main psychiatric problems in general hospital inpatients. It often complicates the treatment and prognosis of patients with active medical conditions. However, the phenomenology of delirium is heterogeneous and hypoactive subtypes of delirium are frequently under-recognized or misdiagnosed as depression. Although the crucial component in the management of delirium is an aetiological treatment, using antipsychotics to treat disturbing symptoms remains the clinical standard. This article gives an overview of clinical features, diagnosis, and therapy of delirium due to a general medical condition. Furthermore, a German version of the Delirium Rating Scale and treatment approaches in the C-L psychiatry setting of the University of Medicine of Graz are presented.     

A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

Background

Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine.

Methods

This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours) were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge.

Results

No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17).

Conclusion

Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke.

Trial registration

Nederlands Trial Register NTR1395

     

Validation of a Consensus Method for Identifying Delirium from Hospital Records

Background

Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland.

Methods

A point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to study results, clinical vignettes were compiled from participants'' medical records in a standardised manner, describing any relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus.

Results

From 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5). Against the original study DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR) of 7.8 (95% CI 5.7–12.0) and the negative LR of 0.45 (95% CI 0.40–0.47) for probable delirium (sensitivity 0.58 (95% CI 0.53–0.62); specificity 0.93 (95% CI 0.90–0.95); AUC 0.86 (95% CI 0.82–0.89)). The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9–4.3) and negative LR 0.15 (95% CI 0.11–0.21) (sensitivity 0.89 (95% CI 0.85–0.91); specificity 0.75 (95% CI 0.71–0.79); AUC 0.86 (95% CI 0.80–0.89)).

Conclusions

This chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights into the inter-relationship between acute illness, as an exposure, for a range of chronic health outcomes.     

Temperature Variability during Delirium in ICU Patients: An Observational Study

Introduction

Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU) and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and –nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature.

Methods

We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or –nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome) and absolute body temperature (secondary outcome) were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores.

Results

Temperature variability was increased during delirium-days compared to days without delirium (β_unadjusted=0.007, 95% confidence interval (CI)=0.004 to 0.011, p<0.001). Adjustment for confounders did not alter this result (β_adjusted=0.005, 95% CI=0.002 to 0.008, p<0.001). Delirium was not associated with absolute body temperature (β_unadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.61). This did not change after adjusting for confounders (β_adjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.63).

Conclusions

Our study suggests that temperature variability is increased during ICU delirium.     

A clinical method of estimating risk of drug induced delirium

A clinical research method for estimating risk of drug induced acute organic mental syndromes or delirium is described. The method was tested on two patient populations where delirium is expected to occur, and one population where mild organic mental syndromes occur. In two populations, post-cardiotomy and post-cataractectomy states, the drug risk number separated delirium from non-delirium subjects. Subjects with mild acute organic mental syndrome after electroconvulsive therapy also had a higher average drug risk number than comparison subjects.     

Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series

Background

Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.

Methods and Findings

We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I²=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I²=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.

Conclusions

In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.     

老年骨科全麻患者术后麻醉恢复室谵妄的影响因素分析及防范措施

目的:分析老年骨科全麻患者术后麻醉恢复室谵妄的影响因素,并探讨相关防范措施。方法:选取2018年7月-2020年6月期间我院收治的200例老年骨科全麻患者,收集患者的临床资料。根据其术后麻醉恢复室是否出现谵妄分为观察组(术后发生谵妄)和对照组(术后未发生谵妄),分析术后麻醉恢复室谵妄的影响因素。结果:200例老年骨科全麻患者中,发生术后谵妄的患者83例,发生率为41.50%(83/200)。单因素分析结果显示,老年骨科全麻患者术后麻醉恢复室谵妄与年龄、合并其它基础疾病、吸烟史、术前血糖、术前血红蛋白、术前红细胞压积、手术类型、术中失血量、电解质紊乱有关(P<0.05),而与性别、体质量指数(BMI)、Zung焦虑自评量表(SAS)评分、术前总蛋白、抑郁自评量表(SDS)评分、血钾、手术时间无关(P>0.05)。多因素Logistic回归分析结果显示:年龄>75岁、合并其它基础疾病、术前血红蛋白<12g/dl、术中失血量≥200 mL、电解质紊乱均为老年骨科全麻患者术后发生谵妄的危险因素(P<0.05)。结论:引起老年骨科全麻患者术后麻醉恢复室谵妄的危险因素较多,包括年龄、合并其它基础疾病、术前血红蛋白、术中失血量、电解质紊乱等,临床应采取必要的防范措施,合理制定手术方案,以降低患者术后谵妄的发生率。     

A review of delirium rating scales

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly general hospital patients. However, the diagnosis of delirium is often missed. The use of rating scales can be helpful in detecting and measuring delirium symptom severity. This article reviews recent developments with regard to psychometric qualities, measurement goal, content and rating procedures of some of the available rating scales in clinical practise. Studies that used delirium rating scales were searched for using the MEDLINE and subsequent examination of reference lists. Ten rating scales were selected for further evaluation. The Confusional Assessment Method (CAM), NEECHAM Confusion Scale (NEECHAM) and Delirium Observation Scale (DOS) appear to be most suitable as a screening instrument, depending on the type of rater (physician or nurse). The (revised) Delirium Rating Scale (DRS(-R-98)) seems to be particularly useful for measuring delirium severity or monitoring change.