Research Progress of Delirium after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RENYan , ZHANGLi-li ,  ZENGLing

Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZENGLing, Email: zenglin510@163.com

Keywords：

Cardiac surgery; Delirium; Diagnosis; Treatment; Prevention; Risk factor

DOI：

10.7507/1007-4848.20140235

Video：

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Delirium is an acute, transient, usually reversible, fluctuating disturbance in consciousness, attention, cognition, and perception. Delirium after cardiac operations is associated with increased morbidity, reduced cognitive functioning, increased short-term and long-term mortality, longer hospitalization and higher hospitalization cost. The diagnosis, prevention and treatment of delirium are of great importance for perioperative care of patients undergoing cardiac surgery. Effective delirium screening tools are very helpful for the recognition and monitoring of delirium after cardiac surgery. In recent years, there has been many new strategies for the treatment, nursing care and prevention of delirium after cardiac surgery. This review focuses on the incidence, risk factors, diagnostic methods, treatment and preventive strategies of delirium after cardiac surgery.

Citation： RENYan, ZHANGLi-li, ZENGLing. Research Progress of Delirium after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 822-825. doi: 10.7507/1007-4848.20140235 Copy

1.	劉勝中, 叢偉, 甘崇志, 等.體外循環心臟直視手術后并發精神障礙的臨床分析.中國胸心血管外科臨床雜志, 2009, 16(1):71-72.
2.	Choi JG. Delirium in the intensive care unit. Korean J Anesthesiol, 2013, 65(3):195-202.
3.	Koster S, Hensens AG, Schuurmans MJ, et al. Consequences of delirium after cardiac operations. Ann Thorac Surg, 2012, 93(3):705-711.
4.	O'regan NA, Fitzgerald J, Timmons S, et al. Delirium:a key challenge for perioperative care. Int J Surg, 2013, 11(2):136-144.
5.	Jodati A, Safaie N, Raoofi M, et al. Prevalence and risk factors of postoperative delirium in patients undergoing open heart surgery in northwest of Iran. J Cardiovasc Thorac Res, 2013, 5(3):97-99.
6.	Corona A, Mondin F, Silvia S, et al. Delirium--a further complication for patients undergoing heart surgery? Crit Care Med, 2013, 41(9):e236-e237.
7.	呂春梅, 李杏崧, 莫韶妹, 等. ICU譫妄患者分型護理干預效果觀察.當代護士, 2012, 7:115-117.
8.	蘇云術, 徐利軍, 魏翔.心臟術后譫妄的原因分析與處理對策.廣州醫學院學報, 2013, 41(4):94-96.
9.	劉威, 齊娟, 于榮國, 等.體外循環術中局部腦氧飽和度與術后譫妄的關系.福建醫科大學學報, 2011, 45(2):143-145.
10.	Lin YY, Chen J, Wang Z. Meta-Analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4):481-492.
11.	Kazmierski J, Banys A, Latek J, et al. Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery. Int Psychogeriatr, 2014, 26(5):845-855.
12.	Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery a prospective observational cohort study. Ann Surg, 2013, 257(6):1160-1167.
13.	Arenson BG, MacDonald LA, Grocott HP, et al. Effect of intensive care unit environment on in-hospital delirium after cardiac surgery. J Thorac Cardiovasc Surg, 2013, 146(1):172-178.
14.	Andrejaitiene J, Sirvinskas E. Early post-cardiac surgery delirium risk factors. Perfusion, 2012, 27(2):105-112.
15.	Miyazaki S, Yoshitani K, Miura N, et al. Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact Cardiovasc Thorac Surg, 2011, 12(3):379-383.
16.	Baranyi A, Rothenh?usler HB. The impact of intra-and postoperative albumin levels as a biomarker of delirium after cardiopulmonary bypass:results of an exploratory study. Psychiatry Res, 2012, 200(2-3):957-963.
17.	Koster S, Hensens AG, Schuurmans MJ, et al. Risk factors of delirium after cardiac surgery A systematic review. Eur J Cardiovasc Nurs, 2011, 10(4):197-204.
18.	Tse L, Schwarz SK, Bowering JB, et al. Pharmacological risk factors for delirium after cardiac surgery:a review. Curr Neuropharmacol, 2012, 10(3):181-196.
19.	Taipale PG, Ratner PA, Galdas PM, et al. The association between nurse-administered midazolam following cardiac surgery and incident delirium:An observational study. Int J Nurs Stud, 2012, 49(9):1064-1073.
20.	Manji RA, Grocott HP, Leake J, et al. Seizures following cardiac surgery:the impact of tranexamic acid and other risk factors. Can J Anaesth, 2012, 59(1):6-13.
21.	Grover S, Kate N. Assessment scales for delirium:A review. World J Psychiatry, 2012, 2(4):58-70.
22.	鄒姮婧, 梅偉, 張傳漢, 等.重癥監護譫妄評定方法在術后患者中使用的信度和效度檢驗.中華行為醫學與腦科學雜志, 2010, 19(11):1046-1047.
23.	Klugkist M, Sedemund-Adib B, Schmidtke C, et al. Confusion Assessment Method for the Intensive Care Unit(CAM-ICU):diag-nosis of postoperative delirium in cardiac surgery. Anaesthesist, 2008, 57(5):464-474.
24.	穆東亮, 王東信, 李立環, 等.冠狀動脈旁路移植手術后早期譫妄與認知功能障礙的關系.北京大學學報:醫學版, 2011, 43(2):242-249.
25.	王儒林, 楊曉軍, 馬玉杰, 等.中文版重癥監護譫妄篩查量表評估ICU譫妄患者的臨床研究.中國實用護理雜志, 2013, 29(30):12-14.
26.	劉尚昆, 梅偉, 張治國, 等.重癥監護譫妄篩查量表在麻醉蘇醒期患者中使用的信效度分析.護理學雜志, 2010, 25(10):4-7.
27.	Norkienė I, Ringaitienė D, Kuzminskaitė V, et al. Incidence and risk factors of early delirium after cardiac surgery. Biomed Res Int, 2013, 2013:323491. doi:10.1155/2013/323491.
28.	梅偉, 劉尚昆, 張治國, 等.中文版護理譫妄篩查量表的信度和效度研究.中華護理雜志, 2010, 45(2):101-104.
29.	Lingehall HC, Smulter N, Engstr?m KG, et al. Validation of the Swedish version of the Nursing Delirium Screening Scale used in patients 70 years and older undergoing cardiac surgery. J Clin Nurs, 2013, 22(19-20):2858-2866.
30.	Olson T. Delirium in the intensive care unit:role of the critical care nurse in early detection and treatment. Dynamics, 2012, 23(4):32-36.
31.	Tagarakis GI, Voucharas C, Tsolaki F, et al. Ondasetron versus haloperidol for the treatment of postcardiotomy delirium:a prospective, randomized, double-blinded study. J Cardiothorac Surg, 2012, 7(3):25-29.
32.	李穎, 許衛江, 劉彬.右美托咪定在心臟術后興奮型譫妄治療中的應用價值.實用臨床醫藥雜志, 2013, 17(13):90-91, 96.
33.	Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. Heart Surg Forum, 2011, 14(2):e93-e98.
34.	Hudetz JA, Patterson KM, Iqbal Z, et al. Ketamine attenuates delir-ium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2009, 23(5):651-657.
35.	Sharma CV, Stacey S, Yate P. Reducing post-cardiopulmonary bypass delirium:more ketamine or less etomidate? J Cardiothorac Vasc Anesth, 2011, 25(3):581-582.
36.	Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation, 2013, 127(15):1576-1584.
37.	李璐.老年人心臟術后譫妄的護理研究進展.中國實用護理雜志, 2012, 28(z2):67.
38.	張偉英, 孫燕, 葉文琴.冠狀動脈旁路移植術后譫妄的研究進展.中華護理雜志, 2013, 48(9):859-862.
39.	Lee J, Jung J, Noh JS, et al. Perioperative psycho-educational inter-vention can reduce postoperative delirium in patients after cardiac surgery:a pilot study. Int J Psychiatry Med, 2013, 45(2):143-158.
40.	羅德生, 王慧, 方敏, 等.術前訪視對預防心臟外科術后患者ICU綜合征的效果觀察.護理實踐與研究, 2012, 9(2):36-37.

1. 劉勝中, 叢偉, 甘崇志, 等.體外循環心臟直視手術后并發精神障礙的臨床分析.中國胸心血管外科臨床雜志, 2009, 16(1):71-72.
2. Choi JG. Delirium in the intensive care unit. Korean J Anesthesiol, 2013, 65(3):195-202.
3. Koster S, Hensens AG, Schuurmans MJ, et al. Consequences of delirium after cardiac operations. Ann Thorac Surg, 2012, 93(3):705-711.
4. O'regan NA, Fitzgerald J, Timmons S, et al. Delirium:a key challenge for perioperative care. Int J Surg, 2013, 11(2):136-144.
5. Jodati A, Safaie N, Raoofi M, et al. Prevalence and risk factors of postoperative delirium in patients undergoing open heart surgery in northwest of Iran. J Cardiovasc Thorac Res, 2013, 5(3):97-99.
6. Corona A, Mondin F, Silvia S, et al. Delirium--a further complication for patients undergoing heart surgery? Crit Care Med, 2013, 41(9):e236-e237.
7. 呂春梅, 李杏崧, 莫韶妹, 等. ICU譫妄患者分型護理干預效果觀察.當代護士, 2012, 7:115-117.
8. 蘇云術, 徐利軍, 魏翔.心臟術后譫妄的原因分析與處理對策.廣州醫學院學報, 2013, 41(4):94-96.
9. 劉威, 齊娟, 于榮國, 等.體外循環術中局部腦氧飽和度與術后譫妄的關系.福建醫科大學學報, 2011, 45(2):143-145.
10. Lin YY, Chen J, Wang Z. Meta-Analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4):481-492.
11. Kazmierski J, Banys A, Latek J, et al. Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery. Int Psychogeriatr, 2014, 26(5):845-855.
12. Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery a prospective observational cohort study. Ann Surg, 2013, 257(6):1160-1167.
13. Arenson BG, MacDonald LA, Grocott HP, et al. Effect of intensive care unit environment on in-hospital delirium after cardiac surgery. J Thorac Cardiovasc Surg, 2013, 146(1):172-178.
14. Andrejaitiene J, Sirvinskas E. Early post-cardiac surgery delirium risk factors. Perfusion, 2012, 27(2):105-112.
15. Miyazaki S, Yoshitani K, Miura N, et al. Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact Cardiovasc Thorac Surg, 2011, 12(3):379-383.
16. Baranyi A, Rothenh?usler HB. The impact of intra-and postoperative albumin levels as a biomarker of delirium after cardiopulmonary bypass:results of an exploratory study. Psychiatry Res, 2012, 200(2-3):957-963.
17. Koster S, Hensens AG, Schuurmans MJ, et al. Risk factors of delirium after cardiac surgery A systematic review. Eur J Cardiovasc Nurs, 2011, 10(4):197-204.
18. Tse L, Schwarz SK, Bowering JB, et al. Pharmacological risk factors for delirium after cardiac surgery:a review. Curr Neuropharmacol, 2012, 10(3):181-196.
19. Taipale PG, Ratner PA, Galdas PM, et al. The association between nurse-administered midazolam following cardiac surgery and incident delirium:An observational study. Int J Nurs Stud, 2012, 49(9):1064-1073.
20. Manji RA, Grocott HP, Leake J, et al. Seizures following cardiac surgery:the impact of tranexamic acid and other risk factors. Can J Anaesth, 2012, 59(1):6-13.
21. Grover S, Kate N. Assessment scales for delirium:A review. World J Psychiatry, 2012, 2(4):58-70.
22. 鄒姮婧, 梅偉, 張傳漢, 等.重癥監護譫妄評定方法在術后患者中使用的信度和效度檢驗.中華行為醫學與腦科學雜志, 2010, 19(11):1046-1047.
23. Klugkist M, Sedemund-Adib B, Schmidtke C, et al. Confusion Assessment Method for the Intensive Care Unit(CAM-ICU):diag-nosis of postoperative delirium in cardiac surgery. Anaesthesist, 2008, 57(5):464-474.
24. 穆東亮, 王東信, 李立環, 等.冠狀動脈旁路移植手術后早期譫妄與認知功能障礙的關系.北京大學學報:醫學版, 2011, 43(2):242-249.
25. 王儒林, 楊曉軍, 馬玉杰, 等.中文版重癥監護譫妄篩查量表評估ICU譫妄患者的臨床研究.中國實用護理雜志, 2013, 29(30):12-14.
26. 劉尚昆, 梅偉, 張治國, 等.重癥監護譫妄篩查量表在麻醉蘇醒期患者中使用的信效度分析.護理學雜志, 2010, 25(10):4-7.
27. Norkienė I, Ringaitienė D, Kuzminskaitė V, et al. Incidence and risk factors of early delirium after cardiac surgery. Biomed Res Int, 2013, 2013:323491. doi:10.1155/2013/323491.
28. 梅偉, 劉尚昆, 張治國, 等.中文版護理譫妄篩查量表的信度和效度研究.中華護理雜志, 2010, 45(2):101-104.
29. Lingehall HC, Smulter N, Engstr?m KG, et al. Validation of the Swedish version of the Nursing Delirium Screening Scale used in patients 70 years and older undergoing cardiac surgery. J Clin Nurs, 2013, 22(19-20):2858-2866.
30. Olson T. Delirium in the intensive care unit:role of the critical care nurse in early detection and treatment. Dynamics, 2012, 23(4):32-36.
31. Tagarakis GI, Voucharas C, Tsolaki F, et al. Ondasetron versus haloperidol for the treatment of postcardiotomy delirium:a prospective, randomized, double-blinded study. J Cardiothorac Surg, 2012, 7(3):25-29.
32. 李穎, 許衛江, 劉彬.右美托咪定在心臟術后興奮型譫妄治療中的應用價值.實用臨床醫藥雜志, 2013, 17(13):90-91, 96.
33. Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. Heart Surg Forum, 2011, 14(2):e93-e98.
34. Hudetz JA, Patterson KM, Iqbal Z, et al. Ketamine attenuates delir-ium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2009, 23(5):651-657.
35. Sharma CV, Stacey S, Yate P. Reducing post-cardiopulmonary bypass delirium:more ketamine or less etomidate? J Cardiothorac Vasc Anesth, 2011, 25(3):581-582.
36. Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation, 2013, 127(15):1576-1584.
37. 李璐.老年人心臟術后譫妄的護理研究進展.中國實用護理雜志, 2012, 28(z2):67.
38. 張偉英, 孫燕, 葉文琴.冠狀動脈旁路移植術后譫妄的研究進展.中華護理雜志, 2013, 48(9):859-862.
39. Lee J, Jung J, Noh JS, et al. Perioperative psycho-educational inter-vention can reduce postoperative delirium in patients after cardiac surgery:a pilot study. Int J Psychiatry Med, 2013, 45(2):143-158.
40. 羅德生, 王慧, 方敏, 等.術前訪視對預防心臟外科術后患者ICU綜合征的效果觀察.護理實踐與研究, 2012, 9(2):36-37.

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