术前熟悉外科重症监护室环境对胸外科老年患者术后谵妄发生率的影响

Effect of Preoperative SICU Environment Familiarization on Incidence of Postoperative Delirium in Elderly Patients Undergoing Thoracic Surgery

目的:探讨术前熟悉外科重症监护室(surgical intensive care unit,SICU)环境能否降低胸外科老年患者术后谵妄的发生率。方法:选择65岁以上择期行胸外科手术且预期术后进入SICU 3 d以上并签署知情同意书的患者296例。根据随机数字表法分成术前SICU环境熟悉组(EF组,n=147)和对照组(n=149),采用ICU意识混乱评价法(confusion assessment methodfor the ICU,CAM-ICU)进行谵妄评估,采用酶联免疫吸附法测定术前1 d以及术后24、48和72 h患者血清皮质醇浓度。采用40项恢复质量评分(40-item quality of recovery score,QoR40)评估术后恢复情况。结果:EF组术后谵妄发生率及持续时间分别为15.65%(23/147)、(35.20±1.82)h,均低于对照组[30.20%(45/149)、(73.23±2.68)h],P<0.05;其中EF组术后48 h谵妄人数5例,占3.40%,低于对照组[15例(10.07%)],P<0.05。EF组术后24、48和72 h皮质醇浓度分别为(614.03±242.80)、(442.87±82.23)、(369.45±84.42)nmol/L,均低于对照组[(879.21±154.43)、(737.67±148.90)、(641.13±163.78)nmol/L]P<0.05;对照组术后各时间段皮质醇浓度均高于术前[(404.19±75.34)nmol/L],P<0.05;EF组仅术后24 h皮质醇浓度与术前[(382.04±13.38)nmol/L]比较差异有统计学意义(P<0.05)。EF组术后24和48 h QoR40评分分别为(137.96±30.22)、(143.64±29.34),均高于对照组[(125.04±28.33)、(129.44±39.76)]P<0.05;在SICU时间和住院时间分别为(3.98±0.99)d、(17.58±10.73)d,均少于对照组[(6.22±3.94)d、(22.54±13.21)d]P<0.05。结论:术前熟悉SICU环境能减少胸外科老年患者术后谵妄的发生率及持续时间,还可改善老年患者术后恢复质量。

Objective：To investigate whether preoperative surgical intensive care unit（SICU） environment familiarization could decrease the incidence of postoperative delirium in elderly patients undergoing thoracic surgery.Methods：A total of 296 patients over 65 years old whom were expected to stay more than 3 days in SICU after elective thoracic surgery were selected.Informed consent was obtained in all patients,and they were randomly divided into environment familiarization group（EF group,n=147） and control group（n=149）.The diagnosis of delirium was made according to confusion assessment method for the ICU（CAM-ICU）.Serum cortisol concentration was measured at 1 d before operation,as well as at 24,48 and 72 h after operation in SICU by enzyme-linked immunosorbent assay.Postoperative recovery was evaluated by 40-item quality of recovery score（QoR40） after operation.Results： The incidence and duration of postoperative delirium in EF group were 15.65 %（23/147） and（35.20±1.82）h,which were lower than those in control group30.20 %（45/149） and（73.23±2.68）h（P0.05）.Compared with the EF group5（3.40 %）,there were more delirium patients in control group15（10.07 %） at 48 h after operation（P0.05）.At 24,48 and 72 h after operation,serum cortisol concentrations in EF group were（614.03±242.80）,（442.87±82.23） and（369.45±84.42）nmol/L,which were lower than those in control group（879.21±154.43）,（737.67±148.90） and（641.13±163.78）nmol/L（P0.05）.Serum cortisol concentrations in control group after operation were significant higher than that before operation（404.19±75.34）nmol/L.There was a significant increase（P0.05） at 24 h after operation in EF group compared with that before operation（382.04±13.38）nmol/L.QoR40 scores in EF group were（137.96±30.22） and（143.64±29.34） at 24 and 48 h after operation,which were significantly higher（P0.05） than those in control group（125.04±28.33） and（129.44±39.76）.The duration of SICU and hospital stay in EF group were（3.98±0.99）d and（17.58±10.73）d,respectively,which were significantly shorter（P0.05） than those in control group（6.22±3.94）d and（22.54±13.21）d.Conclusions： Preoperative environment familiarization can reduce the incidence and duration of postoperative delirium in elderly patients undergoing thoracic surgery and improve the quality of postoperative recovery.