Methods To explore the level of delirium knowledge of geriatric nurses in Sichuan province and analyze the factors, so as to provide the basis for systematic and targeted knowledge training on delirium and clinical management. Methods Using the self-designed “the Questionnaire of Elderly Delirium Knowledge”, geriatric nurses from 22 hospitals in Sichuan province were investigated through a convenient sampling method from September 2018 to February 2019. Results A total of 475 geriatric nurses were investigated. The average delirium knowledge score of the 475 geriatric nurses was 69.51±12.42. Multiple linear regression analysis showed that the main factors affecting the score of delirium-related knowledge were the education of nurses (P=0.037), technical title (P<0.001), years of working in the geriatric department (P=0.001), and the level of working hospital (P=0.001). Conclusions The level of delirium knowledge of geriatric nurses is low and can not meet the needs of clinical work. Nursing managers should carry out delirium knowledge training according to the different characteristics of nurses.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, aortic dissection, surgical duration, intubation time, and ICU stay may be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer surgical and intubation times are associated with an increased risk of delirium in patients undergoing TEVAR. No significant factors influencing delirium are identified in patients undergoing EVAR.
ObjectiveTo investigate the risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 97 mechanically ventilated non-hypertensive patients with COPD who were admitted to this department from January 2018 to October 2018 were selected as subjects. The patients were divided into 49 cases with delirium and 48 cases non-delirium according to the Consciousness Assessment Method for the Intensive Care Uint. The examined data were collected in the patients such as pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), neuron-specific enolase (NSE), and Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores were calculated in the pre-mechanical (d0) and mechanically ventilated 3rd (d3), 5th (d5) days. The mechanical ventilation days were recorded in the two groups. Logistic regression analysis was used to screen the risk factors influencing delirium of patients.ResultsThe PaCO2, NSE, APACHEⅡ scores and mechanical ventilation days were higher in the delirium group than in the non-delirium group ［(88.1±7.5) vs. (85.3±6.2) mm Hg; (28.4±5.8) vs. (26.1±3.3) μg/L; (23.7±3.9) vs. (21.7±2.6); (7.5±1.3) d vs. (6.6±1.2) d］ and PaO2 were lower than non-delirium group ［(54.9±5.5) vs. (57.2±3.1) mm Hg］, the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that PaO2, NSE, APACHEⅡ scores and mechanical ventilation days were risk factors for delirium in mechanically ventilated patients with COPD (regression coefficients were –0.177, 0.163, 0.203, 0.597 respectively, P<0.05). The PaO2 and APACHEⅡ scores of mechanical ventilation on the 3rd and 5th day of the two groups ［d3 (88.3±5.3) vs. (89.1±6.9) mm Hg; d5 (90.3±9.0) vs. (91.3±6.4) mm Hg; d3 (21.7±3.0) vs. (21.4±2.2); d5 (20.9±2.8) vs. (20.7±2.1)］ were not statistically significant (P>0.05).The NSE changes on the 3rd and 5th day of mechanical ventilation ［d3 (30.0±5.3) vs. (26.8±3.6) μg/L; d5 (27.3±4.3) vs. (25.7±2.6) μg/L］ were statistically significant (P<0.05).ConclusionPaO2, NSE, APACHEⅡ score and mechanical ventilation days are risk factors for delirium in COPD patients with mechanical ventilation and NSE is one of the more important risk factors.
ObjectiveTo evaluate the quality of guidelines for the management of delirium in adult patients in the last ten years, so as to provide references for updating, selection, implementation guidelines and delirium management optimization.MethodsWe searched guidelines from databases including PubMed, EMbase, WanFang Data and CNKI, and websites of guidelines from January 1st 2010 to September 1st 2019. Guidelines were comprehensively screened, evaluated based on AGREE Ⅱ and data was independently extracted by two researchers.ResultsGuidelines of NICE, RNAO and SIGN had higher scores, while CSCCM’s and IPS’s gained lower. Among domains of AGREE Ⅱ, Domain I (scope and purpose) and IV (clarity of presentation) scored the highest, with a minimum of Domain Ⅱ (stakeholder involvement) and V (applicability). Delirium management focused on screening, prediction, prevention and treatment both pharmacologically and non-pharmacologically, and information support.ConclusionsFuture development of delirium guidelines should follow the methodology of guideline development, update or adjustment, and dedicate to every domain, especially domain of application. Medical staffs can establish our own domestic guidelines based on high quality guidelines, to promote knowledge translation and delirium management.
目的：观察慢性酒精中毒所致震颤谵妄的临床特点及预后。方法：对32例慢性酒精中毒所致震颤谵妄患者的临床资料进行回顾性分析，探讨其临床特点及预后。结果：32例患者中，因应激方式不当饮酒者19例，平均饮酒年龄20.3±9.6年，平均每日摄入乙醇量276.4±21.9 g。因戒断而出现临床症状者15例。临床表现为多种精神症状和不同程度的意识障碍，伴有肢体震颤。头部CT扫描发现脑萎缩者30例。经治疗后症状痊愈者25人，好转者4人。结论：慢性酒精中毒所致震颤谵妄发作的病理生理机制尚不明了，但其发作与戒断关系密切，经积极干预可获得较满意的预后。
Postoperative delirium is one of the most common postoperative complications in elderly patients, affecting the outcome of approximately half of surgical patients. The pathogenesis of postoperative delirium is still unclear, but multivariate models of the etiology of postoperative delirium are well-validated and widely accepted, and 40% of postoperative delirium can be effectively prevented by targeting predisposing factors. Benzodiazepines have long been considered as predisposing factors for postoperative delirium. Although benzodiazepines are widely used in clinical practice, most relevant guidelines recommend avoiding the use of benzodiazepines in the perioperative period to reduce the incidence of postoperative delirium. Controversy exists regarding the association of benzodiazepine use with postoperative delirium. This article discusses the results of studies on perioperative benzodiazepines and postoperative delirium.
Objective To investigate the evaluation, risk factors and intervening measures of postoperative delirium in patients after liver transplantation, and to provide reference for clinical practice. Methods The relevant literatures on delirium after liver transplantation at home and abroad in recent years were consulted. Based on the definition of postoperative delirium, the research status, evaluation tools and evaluation frequency at home and abroad were reviewed. From the aspects of donor and recipient, the influencing factors by connecting preoperative, intraoperative and postoperative stages and angles were explored. Results The incidence of postoperative delirium in patients with liver transplantation was high, and the risk factors were numerous, which ran through before and after liver transplantation. In terms of research type, most domestic and foreign studies were retrospective, single center, small sample surveys, with different assessment tools and assessment frequency. There were few high-quality intervention studies on delirium after liver transplantation. Conclusions Delirium after liver transplantation is predictable, evaluable and treatable. Effective risk assessment and screening are very important. Intervention for patients undergoing liver transplantation who develop postoperative delirium requires a combination of pharmacologic and non-pharmacologic interventions.
ObjectiveTo determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.MethodsThis retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.ResultsA total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900).ConclusionAnesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.