冠状动脉搭桥术后谵妄的研究现状
|
摘要
冠状动脉搭桥手术越来越普遍,术后谵妄成为影响冠状动脉搭桥手术预后的一大难题。术后谵妄不仅影响患者心肺功能恢复,延长术后ICU滞留时间及住院时间,增加医疗负担,并且与术后并发症发生率及死亡率的增加密切相关。本文从谵妄的定义、易感因素、发病机制、术后评估、治疗几个方面做一综述,旨在总结以往研究经验,发掘围手术期实际有效的干预措施,提高临床医生对冠状动脉搭桥术后谵妄的认识和管理水平。
Coronary artery bypass grafting is becoming more and more common, and postoperative delirium has become a major problem affecting the prognosis of coronary artery bypass grafting. Postoperative delirium not only affects the recovery of cardiopulmonary function, prolongs the duration of ICU stay and hospital stay, increases the medical burden, and is closely related to the increase of postoperative complications and mortality. This article reviews the definitions of sputum, susceptibility factors, pathogenesis, postoperative evaluation, and treatment. It aims to summarize previous research experience, explore practical and effective interventions during perioperative period,improve clinicians' awareness and management of postoperative delirium coronary artery bypass grafting.
Coronary artery bypass grafting is becoming more and more common, and postoperative delirium has become a major problem affecting the prognosis of coronary artery bypass grafting. Postoperative delirium not only affects the recovery of cardiopulmonary function, prolongs the duration of ICU stay and hospital stay, increases the medical burden, and is closely related to the increase of postoperative complications and mortality. This article reviews the definitions of sputum, susceptibility factors, pathogenesis, postoperative evaluation, and treatment. It aims to summarize previous research experience, explore practical and effective interventions during perioperative period,improve clinicians' awareness and management of postoperative delirium coronary artery bypass grafting.
引文
[1]Sockalingam S,Parekh N,Bogoch II,et al.Delirium in the postoperative cardiac patient:a review[J].J Card Surg,2005,20(6):560-567.
[2]American Psychiatric Association.The Diagnostic and Statistical Manual of Mental Disorders-V[M].American Psychiatric Association,2013:152-158.
[3]Jori L,Ed O,Bart VS,et al.The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients:a retrospective study[J].Perfusion,2018,33(3):656-662.
[4]Roggenbach J,Klamann M,von Haken R,et al.Sleep-disordered breathing is a risk factor for delirium after cardiac surgery:a prospective cohort study[J].Crit Care,2014,18(5):477.
[5]Kazmierski J,Banys A,Latek J.Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium:a prospective cohort study[J].Crit Care,2013,17(2):R38.
[6]Alain R,Hülya B,Daniela B,et al.Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU[J].Critical Care,2016,20(1):264.
[7]Radtke FM,Franck M,lorenz M,et al.Remifentanil reduces the incidence of post-operative delirium[J].J Int Med Res,2010,38(4):1225-1232.
[8]Acharya NK,Goldwaser EL,Forsberg MM,et al.Sevoflurane and Isoflurane induce strutural changes in brain vascular endothelial cellls and increase blood-brain barrier perneability:possible link to postperative delirium and cognitive decline[J].Brain Res,2015,1620(4):29-41.
[9]Wiese AJ,Brosnan RJ,Barter LS.Effect of acetylcholinesterase inhibition on quality of recovery from isoflurance-induced anesthesia in horses[J].AM J Vet Res,2014,75(3):223-230.
[10]Hudetz JA,Patterson KM,Idbal Z,et al.Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass[J].Cardiothorac Vasc Anesth,2009,23(5):651-657.
[11]Porhomayon J,Joude PA,Adlparvar G,et al.The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units:A Systematic Review and Meta-Analysis[J].J Cardiovasc Thorac Res,2015,7(2):43-48.
[12]Sanson G,Khlopenyuk Y,Milocco S,et al.Delirium after cardiac surgery.Incidence,phenotypes,predisposing and precipitating risk factors,and effects[J].Heart Lung,2018,47(4):408-417.
[13]Abbott NJ,Patabendige AA,Dolman DE,et al.Structure and function of the blood-brain barrier[J].Neurobiol Dis,2010,37(1):13-25.
[14]de Rooij SE,van Munster BC,Korevaar JC,et al.Cytokines and acute phase response in delirium[J].J Psychosom Res,2007,62(5):521-525.
[15]李晓晴,马闻建,姜霁纹,等.冠状动脉旁路移植术后谵妄的临床研究[J].心肺血管病杂志,2017,36(8):662-664.
[16]Chain KS,Chen CM,Fong Y,et al.Age is an important predictor of failed unplanned extubation[J].Internation Journal of Gerontology,2010,4(3):120-129.
[17]Schoen J,Husemann L,Tiemeyer C,et al.Cognitive function after sevoflurane-vs propofol-based anaesthesthesia for onpump cardiac surgery:a randomized controlled trial[J].Br JAnaesth,2011,106(6):840-850.
[18]Cavallari M,Dai W,Guttmann CRG,et al.Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI[J].Brain,2016,139(Pt4):1282-1294.
[19]Baranyi A,Rothenhausler HB.The impact of soluble interleukin-2 receptor as a biomarker of delirium[J].Psychosomatics,2014,55(1):51-60.
[20]Kazmierski J,Banys A,Latek J,et al.Raised IL-2 and TNF-αconcentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery[J].International Psychogeriatrics,2014,26(5):845-855.
[21]Siddiqi N,Harrison JK,Clegg A,et al.Interventions for preventing delirium in hospitalised patients[J].Cochrane Database Syst Rev,2007,18(2):CD005563.
[22]Kim DH,Huybrechts KF,Patorno E,et al.Adverse events associated with antipsychotic use in hospitalized older adults after cardiac surgery[J].J Am Geriatr Soc,2017,65(6):1229-1237.
[23]Royse CF,Saager L,Whitlock R,et al.Impact of methylprednisolone on postoperative quality of recovery and delirium in the steroids in cardiac surgery trial:a randomized,double-blind,placebo-controlled substudy[J].Anesthesiology,2017,126(2):223-233.
[24]Azeem T,Yosif N,Alansary A,et al.Dexmedetomidine vs morphine and midazolam in the prevention and treatment of delirium after adult cardiac surgery;a randomized,double-blinded clinical trial[J].Saudi Journal of Anaesthesia,2018,12(2):190-197.
[25]Djaiani G,Silverton N,Fedorko L,et al.Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery:A Randomized Controlled Trial[J].Anesthesiology,2016,124(2):362-368.
[26]Priye S,Jagannath S,Singh D,et al.Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery:Arandomized,double-blind study[J].Saudi J Anaesth,2015,9(4):353-358.
[27]Wu MM,Liang YX,Dai Z,et al.Perioperative dexmedetomidine reduces delirium after cardiac surgery:A meta-analysis of randomized controlled trials[J].J Clin Anesth,2018,50(6):33-42.
[28]Wang W,Li HL,Wang DX,et al.Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery:A randomized controlled trial[J].Critical Care Medicine,2012,40(3):731-739.
[29]Al Tmimi L,Van de Velde M,Herijgers P,et al.Xenon for the prevention of postoperative delirium in cardiac surgery:study protocol for a randomized controlled clinical trial[J].Trials,2015,16(5):449.
[30]Luetz A,Weiss B,Penzel T,et al.Feasibility of noise reduction by a modification in ICU environment[J].Physiological Measurement,2016,37(7):1041-1055.
[2]American Psychiatric Association.The Diagnostic and Statistical Manual of Mental Disorders-V[M].American Psychiatric Association,2013:152-158.
[3]Jori L,Ed O,Bart VS,et al.The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients:a retrospective study[J].Perfusion,2018,33(3):656-662.
[4]Roggenbach J,Klamann M,von Haken R,et al.Sleep-disordered breathing is a risk factor for delirium after cardiac surgery:a prospective cohort study[J].Crit Care,2014,18(5):477.
[5]Kazmierski J,Banys A,Latek J.Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium:a prospective cohort study[J].Crit Care,2013,17(2):R38.
[6]Alain R,Hülya B,Daniela B,et al.Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU[J].Critical Care,2016,20(1):264.
[7]Radtke FM,Franck M,lorenz M,et al.Remifentanil reduces the incidence of post-operative delirium[J].J Int Med Res,2010,38(4):1225-1232.
[8]Acharya NK,Goldwaser EL,Forsberg MM,et al.Sevoflurane and Isoflurane induce strutural changes in brain vascular endothelial cellls and increase blood-brain barrier perneability:possible link to postperative delirium and cognitive decline[J].Brain Res,2015,1620(4):29-41.
[9]Wiese AJ,Brosnan RJ,Barter LS.Effect of acetylcholinesterase inhibition on quality of recovery from isoflurance-induced anesthesia in horses[J].AM J Vet Res,2014,75(3):223-230.
[10]Hudetz JA,Patterson KM,Idbal Z,et al.Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass[J].Cardiothorac Vasc Anesth,2009,23(5):651-657.
[11]Porhomayon J,Joude PA,Adlparvar G,et al.The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units:A Systematic Review and Meta-Analysis[J].J Cardiovasc Thorac Res,2015,7(2):43-48.
[12]Sanson G,Khlopenyuk Y,Milocco S,et al.Delirium after cardiac surgery.Incidence,phenotypes,predisposing and precipitating risk factors,and effects[J].Heart Lung,2018,47(4):408-417.
[13]Abbott NJ,Patabendige AA,Dolman DE,et al.Structure and function of the blood-brain barrier[J].Neurobiol Dis,2010,37(1):13-25.
[14]de Rooij SE,van Munster BC,Korevaar JC,et al.Cytokines and acute phase response in delirium[J].J Psychosom Res,2007,62(5):521-525.
[15]李晓晴,马闻建,姜霁纹,等.冠状动脉旁路移植术后谵妄的临床研究[J].心肺血管病杂志,2017,36(8):662-664.
[16]Chain KS,Chen CM,Fong Y,et al.Age is an important predictor of failed unplanned extubation[J].Internation Journal of Gerontology,2010,4(3):120-129.
[17]Schoen J,Husemann L,Tiemeyer C,et al.Cognitive function after sevoflurane-vs propofol-based anaesthesthesia for onpump cardiac surgery:a randomized controlled trial[J].Br JAnaesth,2011,106(6):840-850.
[18]Cavallari M,Dai W,Guttmann CRG,et al.Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI[J].Brain,2016,139(Pt4):1282-1294.
[19]Baranyi A,Rothenhausler HB.The impact of soluble interleukin-2 receptor as a biomarker of delirium[J].Psychosomatics,2014,55(1):51-60.
[20]Kazmierski J,Banys A,Latek J,et al.Raised IL-2 and TNF-αconcentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery[J].International Psychogeriatrics,2014,26(5):845-855.
[21]Siddiqi N,Harrison JK,Clegg A,et al.Interventions for preventing delirium in hospitalised patients[J].Cochrane Database Syst Rev,2007,18(2):CD005563.
[22]Kim DH,Huybrechts KF,Patorno E,et al.Adverse events associated with antipsychotic use in hospitalized older adults after cardiac surgery[J].J Am Geriatr Soc,2017,65(6):1229-1237.
[23]Royse CF,Saager L,Whitlock R,et al.Impact of methylprednisolone on postoperative quality of recovery and delirium in the steroids in cardiac surgery trial:a randomized,double-blind,placebo-controlled substudy[J].Anesthesiology,2017,126(2):223-233.
[24]Azeem T,Yosif N,Alansary A,et al.Dexmedetomidine vs morphine and midazolam in the prevention and treatment of delirium after adult cardiac surgery;a randomized,double-blinded clinical trial[J].Saudi Journal of Anaesthesia,2018,12(2):190-197.
[25]Djaiani G,Silverton N,Fedorko L,et al.Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery:A Randomized Controlled Trial[J].Anesthesiology,2016,124(2):362-368.
[26]Priye S,Jagannath S,Singh D,et al.Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery:Arandomized,double-blind study[J].Saudi J Anaesth,2015,9(4):353-358.
[27]Wu MM,Liang YX,Dai Z,et al.Perioperative dexmedetomidine reduces delirium after cardiac surgery:A meta-analysis of randomized controlled trials[J].J Clin Anesth,2018,50(6):33-42.
[28]Wang W,Li HL,Wang DX,et al.Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery:A randomized controlled trial[J].Critical Care Medicine,2012,40(3):731-739.
[29]Al Tmimi L,Van de Velde M,Herijgers P,et al.Xenon for the prevention of postoperative delirium in cardiac surgery:study protocol for a randomized controlled clinical trial[J].Trials,2015,16(5):449.
[30]Luetz A,Weiss B,Penzel T,et al.Feasibility of noise reduction by a modification in ICU environment[J].Physiological Measurement,2016,37(7):1041-1055.