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非完全谵妄的发生率、高风险因素及预防护理概述

news 2024/12/18 10:25:08

出处：Yan Gao, Prevalence, risk factors, and outcomes of subsyndromal delirium in older
adults in hospital or long-term care settings: A systematic review and meta-analysis, 重庆第二医科大学，2022

家人胆囊手术后出现术后谵妄，今天看了大概5~6篇论文，这一篇是从NSTL买的，不太贵。论文内容与手术和住院期间的医护活动能够对应得上。

1.术语

Prevalence 流行趋势
Subsyndromal delirium 非原发性谵妄，通常是与比如手术、治疗等伴生出现的。

2.概要

非原发性谵妄在老年群体中的发生率、高风险因子分析以及预防和围术期看护注意事项等。

3.要点

3.1 数据来源

PubMed	Web of Science	OVID	PsycINFO
CINAHL	Cochrane Library	CNKI	CBM
Chongqing VIP	Wanfang databases

searched for studies published from inception to 2021, without language restrictions. Independent reviewers performed quality assessments, data extraction and analysis for all included studies。

最终包含了2426篇论文中的，22个研究案例（针对5125个病人），数据搜集时间截至Aug08,2021

数据搜索关键字：subsyndromal delirium, subclinical delirium

病人都是原自医院和日间照料中心的。

3.1.1 数据类型

cohort studies 占数据总量的50%
- 其中18.2%的样本包含后续analysis studies
- 18.2%的样本包含后续的descriptive studies
- 13.6%是cross-sectional studies.
亚洲样本2个，欧洲5个，15个样本分布在北美。
病人的平均年龄70~87岁；
外科手术样本31.8%；22.7%是内科诊室；22.7%来自日间诊疗中心；9%是双地点

3.2 初步结论

1.发生概率 - 36.4% of 老年人(>=60)

The prevalence of SSD in older adults was 36.4% (95%CI:0.28 to 0.44).

2.主要引发原因 - 老年痴呆、血红蛋白不足等

Significant risk factors were:

老年痴呆 dementia (OR 5.061, 95%CI:2.320 to 11.043),
日常活动频率降低 lower ADL scores (OR 1.706, 95%CI:1.149 to 2.533),
低血红蛋白 lower hemoglobin (SMD -0.21, 95%CI: -0.333 to -0.096),
高龄 advanced age (SMD 0.358, 95% CI:0.194 to 0.522),

3 不良后果 - 认知功能衰退等

SSD was associated with poor outcomes, including

认知与功能衰退 cognitive and functional decline,
需要更久的入院治疗时间 increased length of hospital stay,
更高的死亡几率 a higher mortality rate.

4.分析手段

Reporting Items for Systematic Review and Meta-Analysis (PRISMA) evidence-based guidelines
论文笔记软件：NoteExpress V3.0
两个独立小组的独立分析+复核。
The Newcastle-Ottawa Scale (NOS)
The Agency for Healthcare Research and Quality (AHRQ) recommendation checklist
分析软件 STATA statistical software (version12.0 for Windows).
1. statistics in Pooled statistical analyses
  1. if $eq?I%5E2$ <25%, the fixed effects model was used; if $eq?I%5E2$ >=25%, the random effects model was used.
  2. numbers/counts (categoricaldata) or mean/SD (continuous data)
2. Mantel-Haenszel estimator to calculate the pooled Odds Ratio (OR)
3. analysed publication bias using a combination of two methods:
  1. the Begg test
  2. the funnel plot
4. All tests were conducted with a significance threshold of 5% and a 95% confidence interval (CI).
5. The Confusion Assessment Method (CAM) was used in 17 studies(77.3%), while the Intensive Care Delirium Screening Checklist(ICDSC) was used in one study (5%) (Table 1)

5.分析结论细节

5.1 发生率 - 外科手术有更高的发生率

5.2 突发性疾病的术后谵妄和后续持续性机能丧失不存在相关性：

Data related to the relationship between SSD and functional outcome are conflicting. SSD is associated with poor functional outcomes in medical, surgical and LTC patients.10,20,26 Meanwhile, studies mainly including surgical and critically ill patients did not confirm the association between SSD and worse outcome.14,50