老年综合评估在心外科老年患者术后谵妄预测中的应用  

Research on the prediction of comprehensive geriatric assessment on postoperative delirium in elderly patients in cardiac surgery department

作　　者：陈朝红[1] 李雪苹[1] 陈艳丽[1] 陈小华[1] 林爱玲[1] Chen Chaohong;Li Xueping;Chen Yanli;Chen Xiaohua;Lin Ailing(Department of Cardiothoracic Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Chin)

机构地区：[1]温州医科大学附属第一医院心胸外科,温州325000

出　　处：《中华现代护理杂志》2018年第7期809-813,共5页Chinese Journal of Modern Nursing

摘　　要：目的 探讨老年综合评估（CGA）对老年患者心外科术后谵妄（POD）的预测作用.方法 2015年1月—2016年12月采用方便目的 抽样法选择276例心外科患者为研究对象.记录患者的一般临床资料,并应用老年综合评估问卷进行调查.术后第1~7天应用重症监护病房患者意识模糊评估量表或意识模糊评估量表进行POD评估.采用单因素分析、多元Logistic回归分析探讨老年患者心外科术后发生POD的影响因素.结果 有98例（35.5%）患者术后出现POD.与未出现POD的患者相比,出现POD的患者年龄更大,脑血管病病史、房颤、体外循环、术中输血比例更高,机械通气时间更长,APACHEⅡ评分、术后疼痛评分、血肌酐、C反应蛋白水平更高,CGA评分≥15分的患者比例更高,差异均有统计学意义（P〈0.05）.多元Logistic回归分析显示,脑血管病病史、体外循环、APACHEⅡ评分、术后疼痛评分和CGA评分≥15分为老年心外科术后患者发生POD的独立危险因素.结论 老年综合评估能够预测心外科术后谵妄高危的老年患者,对于防治术后谵妄和改善老年患者预后有一定的意义.Objective To explore the prediction of comprehensive geriatric assessment （CGA） on postoperative delirium （POD） in elderly patients after cardiac surgery. Methods A total of 276 patients from cardiac surgery department were selected from January 2015 to December 2016 by convenience sampling method. The general clinical data of the subjects were recorded and the CGA was conducted. POD assessment was performed on the 1st to the 7th day postoperatively using Confusion Assessment Method-Intensive Care Unit （CAM-ICU） or Confusion Assessment Method （CAM）. Single factor analysis and multiple Logistic regression analysis were applied to analyze the factors influencing the incidence of POD after cardiac surgery in elderly patients. Results A total of 98 cases showed POD, with the incidence of 35.5%. Compared with the non-POD patients, the patients with POD were older; the proportion of history of cerebrovascular disease, atrial fibrillation, cardiopulmonary bypass, intraoperative blood transfusion was higher; the mechanical ventilation duration was longer; the score of Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ）, the postoperative pain score, the level of serum creatinine and C-reactive protein （CRP） were higher; the proportion of patients with CGA score over 15 was significantly higher, and all the differences were statistically significant （P〈 0.05）. Logistic multivariate regression analysis showed that the history of cerebrovascular disease, cardiopulmonary bypass, APACHE Ⅱ score, postoperative pain score and CGA score over 15 were independent risk factors for POD. Conclusions CGA can predict patients with cardiac surgery with high risk of postoperative delirium, which has a certain significance for the prevention and treatment of postoperative delirium and improve the prognosis.

关 键 词：老年人 心脏外科手术 谵妄 老年综合评估 

分 类 号：R473.6[医药卫生—护理学]