老年病人胸腔镜术后亚谵妄综合征发生现状及危险因素

Incidence and risk factors analysis of subsyndromal delirium in elderly patients after thoracoscopic surgery

目的:调查老年病人胸腔镜术后亚谵妄综合征发生现状及其危险因素,为医护人员制定术后亚谵妄综合征的预防措施提供理论依据。方法:选取2021年5月—11月在泸州市某2所三级甲等医院胸外科行择期胸腔镜手术的老年病人作为研究对象。术后每日19:00~22:00采用意识模糊评估量表(CAM)对病人进行亚谵妄评估,直至病人发生谵妄或出院。采用病人一般资料问卷、Barthel指数评定量表、抑郁自评量表(SAS)、焦虑自评量表(SDS)、睡眠状况自评量表、疼痛数字评定量表、Charlson共病指数收集病人术前、术中和术后信息。结果:共纳入320例行胸腔镜手术的老年病人,其中114例发生亚谵妄综合征,发生率为35.6%。二元Logistic分析显示,年龄、术前住院日、SDS评分和术后疼痛是老年病人胸腔镜术后发生亚谵妄综合征的危险因素,术后睡眠时间是老年病人胸腔镜术后发生亚谵妄综合征的保护因素。结论:胸腔镜术后的老年病人亚谵妄综合征发生率较高,且有发展为谵妄的风险,医护人员应重点关注老年病人胸腔镜术后发生亚谵妄综合征的危险因素,制定高危病人的识别、预防和干预措施。

Objective:To investigate the current situation and risk factors of subsyndromal delirium in elderly patients after thoracoscopic surgery,so as to provide theoretical basis for medical staffs to formulate preventive measures of postoperative subsyndromal delirium.Methods:Elderly patients who underwent elective thoracoscopic surgery in the thoracic surgery department of 2 tertiary grade A hospitals in Luzhou city from May to November 2021 were selected as the study objects.Subdelirium was assessed by the Confusion Assessment Method(CAM)from 19:00 to 22:00 every day after surgery until delirium occurred or the patient was discharged.General data questionnaire,Barthel Index(BI),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),Self-Rating Scale of Sleep(SRSS),Number Rating Scale(NRS),Charlson Comorbidity Index were used to collect preoperative,intraoperative and postoperative information of patients.Results:A total of 320 elderly patients underwent thoracoscopic surgery were enrolled.There were 114 elderly patients with subsyndromal delirium,accounting to 35.6%.Binary Logistic regression analysis showed that age,preoperative hospital stay,SDS scores and postoperative pain were risk factors for subsyndromal delirium in elderly patients after thoracoscopic surgery,postoperative sleep time is a protective factor for subsyndromal delirium in elderly patients after thoracoscopic surgery.Conclusions:The incidence of subdelirium syndrome in elderly patients after thoracoscopic surgery was high,and there was risk of developing delirium.Medical staff should focus on the risk factors of the occurrence of subdelirium syndrome after thoracoscopic surgery in elderly patients,and develop the identification,prevention and intervention measures for high-risk patients.