目的:分析脊柱外科患者术后并发谵妄综合征的原因,总结其诊断、预防、治疗。方法:回顾性分析我科2008年10月至2009年4月脊柱手术167例,其中11例患者术后发生谵妄综合征。结果:11例患者均给予氟哌啶醇5mg im bid治疗,平均使用5.6天,症状缓解;并获3~6月随访,无一例复发谵妄综合征。结论:谵妄综合征是脊柱外科患者术后常见并发症,其发生与年龄,性别,低血糖等有关,目前治疗首选氟哌啶醇。
Objective To evaluate the influence of early mobilization on delirium and respiratory dynamics in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The study prospectively recruited 107 AECOPD patients who admitted between January 2014 and June 2015 and underwent mechanical ventilation.On basis of same routine treatment,the patients were randomly divided into a treatment group (54 cases)receiving regime of early mobilization,and a control group (53 cases)receiving routine sedation and analgesia treatment.The incidence of delirium,duration of delirium,time of mechanical ventilation,and ICU mortality were compared between two groups.The respiratory mechanical parameters including endogenous positive end expiratory pressure (PEEPi),airway resistance(Raw),static compliance(Cs),and dynamic compliance(Cd)before treatment,3 days and 5 days after treatment were also compared between two groups. Results Compared with the control group,the incidence of delirium decreased (59.3% vs. 77.4%),the duration of delirium [(1.8±1.1)d vs. (2.6±1.3)d] and mechanical ventilation[(6.2±3.4)d vs. (7.9±4.2)d] reduced in the treatment group with significant difference(P<0.05).There was no significant difference in respiratory mechanical parameters before treatment between two groups(P>0.05).While at 3 days and 5 days after treatment,PEEPi decreased [(6.23±2.83)cm H2O vs. (7.42±2.62)cm H2O,(4.46±2.20)cm H2O vs. (5.92±2.51)cm H2O],Raw decreased [(20.35±7.15)cmH2O·L-1·s-1 vs. (23.23±6.64)cm H2O·L-1·s-1,(16.00±5.41)cm H2O·L-1·s-1 vs. (19.02±6.37)cm H2O·L-1·s-1],Cd increased [(25.20±9.37)mL/cm H2O vs (21.75±7.38)mL/cm H2O,(27.46±5.45)mL/cm H2O vs. (24.40±6.68)mL/cm H2O] in the treatment group compared with the control group(P<0.05),and the difference in Cs was not significant(P>0.05).No complications such as slippage,physical injury,or malignant arrhythmia occurred in two groups.The mortality slightly decreased in the treatment group compared with the control group (5.6% vs 11.3%),but the difference was not statistically significant(P>0.05). Conclusions The incidence of delirium is high in mechanically ventilated patients with AECOPD.Early mobilization can reduce the incidence and duration of delirium,decrease the airway resistance,increase the dynamic lung compliance,relieve dynamic pulmonary hyperinflation and reduce PEEPi,so as to improve the respiratory function and shorten the time of mechanical ventilation.Therefore,early mobilization is an effective and safe regime for AECOPD patients underwent mechanical ventilation.
ObjectiveTo analyze the predictive value of ensemble classification algorithm of random forest for delirium risk in ICU patients with cardiothoracic surgery. MethodsA total of 360 patients hospitalized in cardiothoracic ICU of our hospital from June 2019 to December 2020 were retrospectively analyzed. There were 193 males and 167 females, aged 18-80 (56.45±9.33) years. The patients were divided into a delirium group and a control group according to whether delirium occurred during hospitalization or not. The clinical data of the two groups were compared, and the related factors affecting the occurrence of delirium in cardiothoracic ICU patients were predicted by the multivariate logistic regression analysis and the ensemble classification algorithm of random forest respectively, and the difference of the prediction efficiency between the two groups was compared.ResultsOf the included patients, 19 patients fell out, 165 patients developed ICU delirium and were enrolled into the delirium group, with an incidence of 48.39% in ICU, and the remaining 176 patients without ICU delirium were enrolled into the control group. There was no statistical significance in gender, educational level, or other general data between the two groups (P>0.05). But compared with the control group, the patients of the delirium group were older, length of hospital stay was longer, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, proportion of mechanical assisted ventilation, physical constraints, sedative drug use in the delirium group were higher (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.162), length of hospital stay (OR=1.238), APACHEⅡ score (OR=1.057), mechanical ventilation (OR=1.329), physical constraints (OR=1.345) and sedative drug use (OR=1.630) were independent risk factors for delirium of cardiothoracic ICU patients. The variables in the random forest model for sorting, on top of important predictor variable were: age, length of hospital stay, APACHEⅡ score, mechanical ventilation, physical constraints and sedative drug use. The diagnostic efficiency of ensemble classification algorithm of random forest was obviously higher than that of multivariate logistic regression analysis. The area under receiver operating characteristic curve of ensemble classification algorithm of random forest was 0.87, and the one of multivariate logistic regression analysis model was 0.79.ConclusionThe ensemble classification algorithm of random forest is more effective in predicting the occurrence of delirium in cardiothoracic ICU patients, which can be popularized and applied in clinical practice and contribute to early identification and strengthening nursing of high-risk patients.
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.
Postoperative delirium (POD) is a serious postoperative complication, which is significantly correlated with poor prognosis such as prolonged hospital stay and increased rate of readmission. POD is the result of multiple factors, and intervention targeting at its risk factors can significantly reduce the incidence of POD. At present, POD prevention tends to be multidisciplinary and cluster-oriented, aiming at forming a process-oriented, whole-perioperative assessment and intervention path. However, at present, there are few studies on POD peri-anesthetic period intervention, and there are many controversies. All guidelines and expert consensus are also blank in this part, and further studies are needed to fill the gaps. This paper discusses the current prevention strategies for POD during peri-anesthetic period, guiding future studies and further improving the intervention strategies for POD during peri- anesthetic period, so as to reduce the occurrence of POD.
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.
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。
Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.
ObjectiveTo investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. MethodsClinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. ResultsA total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ2=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.
Postoperative delirium (POD) is a common postoperative complication. Dysregulation of gut flora is involved in POD through mechanisms such as neuroinflammation, oxidative stress, deposition of β-amyloid, and aberrant production of metabolites of gut flora. Therefore, interventions to regulate gut flora, such as probiotics, prebiotics, and faecal microbiota transplantation, can alleviate cognitive dysfunction. This article reviews the mechanisms of gut flora in POD and its prevention and treatment strategies, with the aim of providing new ideas for the clinical prevention and treatment of POD.