在麻醉后护理单位的术后妄和随后的病房妄之间的关联:一个回顾性队列研究
Yotam Weiss1, Shiri Zarour, Daniel Hikry
1From the Division of Anaesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel (YW, SZ, DH, TT, MI, AZ, OG, BC, IM), Department of Peri-Operative Medicine, University College London Hospitals NHS Trust, London, UK (SZ) and Outcomes Research Consortium, Houston, Texas, USA (BC).
在麻醉后护理单位 (PACU-POD) 诊断的术后狂妄症是病房 (ward-POD) 随后狂妄症和其他不良结果的显著早期指标. 常规的PACU查可以改善患者风险分层,并促进及时干预.
科学领域:
- 老年医学 老年医学
- 麻醉学 麻醉学
- 手术结果研究研究.
背景情况:
- 随着手术患者人口的老龄化,需要有效的术后痴呆症 (POD) 查.
- 麻醉后护理单位 (PACU) 是早期发现POD的关键时期,但PACU诊断的POD (PACU-POD) 的意义尚未得到充分理解.
研究的目的:
- 调查PACU-POD与病房POD发展之间的关联.
- 为了确定PACU-POD是否预测其他不良的术后结果.
主要方法:
- 对3781名70岁以上的患者进行了回顾性队列研究,这些患者接受了选择性的非心脏,非部手术.
- 使用4AT和CHART-DEL审查评估的术后妄想.
- 主要结果:病房-POD. 二次结果:跌倒,ICU入院,出院处置,30天死亡率.
主要成果:
- PACU-POD发生在9.1%的患者中,与老年,虚弱,认知障碍和高风险手术有关.
- 患有PACU-POD的患者病房-POD的发生率显著更高 (24.6%与4.3%相比).
- PACU-POD独立预测了病房-POD (aOR 4.4),住院跌倒 (aOR 2.3) 和30天死亡率 (aOR 4.4),以及长时间的PACU和住院.
结论:
- PACU-POD是病房POD和其他术后并发症风险增加的强有力的早期标志物.
- 实施常规的PACU查可以提高早期诊断,风险分层和针对POD的有针对性的干预措施.
- 需要进一步的研究来评估在PACU停留期间启动的早期干预措施对POD轨迹和结果的影响.
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