【原】择期颅脑手术后ICU患者术后谵妄的发生率及危险因素：前瞻性队列研究

罂粟花anesthGH 2021-07-21

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Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery: A prospective cohort study

术后认知功能障碍(POD)已被确认为手术后的重要并发症。然而，在以前的研究中，神经外科患者通常被排除在外。到目前为止，关于颅脑手术后患者POD及其危险因素的研究很少。本研究探讨颅脑手术后POD的发生率及危险因素。

方法

选择2017年3月1日至2018年2月2日期间，北京一所大学附属医院内全麻下择期行颅脑手术的成年患者为研究对象，采用谵妄评分量表对谵妄进行评估。术后第1天或第3天谵妄评估阳性患者诊断为POD。将患者分为POD组和非POD组。收集数据进行单变量和多变量分析，以确定POD的危险因素。

结果

总共有800名患者纳入研究。157名患者诊断为POD(19.6%，95%可信区间16.9-22.4%)。POD的独立危险因素包括年龄、颅内病变性质、开颅手术入路、手术时间、ICU住院时出现低脉搏血氧饱和度、苏醒不完全和苏醒期谵妄、术后疼痛和出现制动事件。POD与不良预后和高住院费用相关。

结论

POD在择期颅内手术的患者中很常见。POD的危险因素和不良预后的潜在关系表明，需要确定一个综合的治疗方案，包括筛查易感因素和早期预防可变因素来更好的管理POD。

原始文献摘要

Wang CM, Huang HW, Wang YM,et,al.Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery: A prospective cohort study.[J].Eur J Anaesthesiol 2020 Jan;37(1) DOI：10.1097/EJA.0000000000001074

BACKGROUND Postoperative delirium (POD) has been confirmed as an important complication after major surgery.However, neurosurgical patients have usually been excluded in previous studies. To date, data on POD and risk factors in patients after intracranial surgery are scarce.

OBJECTIVES To determine the incidence and risk factors of POD in patients after intracranial surgery.

DESIGN Prospective cohort study.

SETTING A neurosurgical ICU of a university-affiliated hospital, Beijing, China.

INTERVENTIONS Adult patients admitted to the ICU after intracranial surgery under general anaesthesia were consecutively enrolled between 1 March 2017 and 2 February 2018. Delirium was assessed using the Confusion Assessment Method for the ICU. POD was diagnosed as Confusion Assessment Method for the ICU positive on either postoperative day 1 or day 3. Patients were classifiedintogroupswithor without POD. Data were collected for univariate and multivariate analyses to determine the risk factors for POD.

RESULTS A total of 800 patients were included. POD was diagnosed in 157 patients (19.6%, 95% confidence interval 16.9 to 22.4%). Independent risk factors for POD included age, nature of intracranial lesion, frontal approach craniotomy,duration of surgery, presence of an episode of low pulse oxygenation at ICU admission, presence of inadequate emergence and emergence delirium, postoperative pain and presence of immobilising events. POD was associated with adverse outcomes and high costs.

CONCLUSION POD is prevalent in patients after elective intracranial surgery. The identified risk factors for and the potential association of POD with adverse outcomes suggest that a comprehensive strategy involving screening for predisposing factors and early prevention of modifiable factors should be established in this population.

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