非心脏大手术后出现谵妄对老年患者长期生存的影响：一项纵向前瞻性观察研究。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-10-22 DOI:10.1016/j.jclinane.2024.111663

Bing-Yan Cai M.D. , Shu-Ting He M.D. , Yan Zhang M.D. , Jia-Hui Ma Ph.D , Dong-Liang Mu M.D. , Dong-Xin Wang M.D., Ph.D

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引用次数: 0

摘要

研究目的验证谵妄的出现可能与长期生存率下降有关的假设：设计：纵向前瞻性观察研究：地点：中国北京一家三级甲等医院：患者：942名年龄在65-90岁之间、在全身麻醉下接受非心脏大手术后入住麻醉后护理病房（PACU）的患者：在PACU住院期间，使用重症监护室意识混乱评估方法对出现的谵妄进行评估：每年对患者进行一次随访，至少持续3年。我们的主要终点是总生存率。次要终点包括无复发生存率和无事件生存率。采用 Cox 比例危险模型分析了出现谵妄与长期存活率之间的关系：在登记的患者中，915 人完成了围手术期评估；906 人完成了长期随访（平均年龄 72 岁；60% [545/906] 为男性；73% [660/906] 接受过癌症手术）。随访结束时（中位数为 43 个月），出现谵妄的 331 名患者中有 69 人死亡（21%），而未出现谵妄的 575 名患者中有 114 人死亡（20%）：未调整危险比为 1.10（95% CI：0.81 至 1.48）；P = 0.547；调整后危险比为 0.96（95% CI：0.70 至 1.32）；P = 0.797。出现谵妄的患者无复发生存率为73/331（22%），而未出现谵妄的患者为121/575（21%）：未调整危险比为1.08（95 % CI：0.81至1.45）；P = 0.598；调整后危险比为0.94（95 % CI：0.69至1.28）；P = 0.695。出现谵妄的患者无事件生存率为159/331（48%），而未出现谵妄的患者为268/575（47%）：未调整危险比为1.06（95 % CI：0.87至1.29）；P = 0.563；调整危险比为0.98（95 % CI：0.80至1.21）；P = 0.875：我们没有发现老年患者在接受全身麻醉和主要针对癌症的大型手术后出现谵妄与长期生存率下降之间存在明显联系。出现谵妄对长期预后的影响值得进一步研究。临床试验注册：www.chictr.org.cn；ChiCTR-OOC-17012734。

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Impact of emergence delirium on long-term survival in older patients after major noncardiac surgery: A longitudinal prospective observational study

Study objective

To test the hypothesis that emergence delirium might be associated with worse long-term survival.

Design

A longitudinal prospective observational study.

Setting

A tertiary hospital in Beijing, China.

Patients

A total of 942 patients aged 65–90 years who were admitted to post-anesthesia care unit (PACU) after major noncardiac surgery under general anesthesia.

Exposures

Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay.

Measurements

Patients were followed up once a year for at least 3 years. Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals. Associations between emergence delirium and long-term survivals were analyzed with the Cox proportional hazard models.

Main results

Among enrolled patients, 915 completed perioperative assessments; 906 completed long-term follow-up (mean age 72 years; 60 % [545/906] male; 73 % [660/906] cancer surgery). At the end of follow-up (median 43 months), there were 69 deaths in 331 patients (21 %) with emergence delirium versus 114 deaths in 575 patients (20 %) without: unadjusted hazard ratio 1.10 (95 % CI: 0.81 to 1.48); P = 0.547; adjusted hazard ratio 0.96 (95 % CI: 0.70 to 1.32); P = 0.797. Recurrence-free survival was 73/331 (22 %) in patients with emergence delirium versus 121/575 (21 %) without: unadjusted hazard ratio 1.08 (95 % CI: 0.81 to 1.45); P = 0.598; adjusted hazard ratio 0.94 (95 % CI: 0.69 to 1.28); P = 0.695. Event-free survival was 159/331 (48 %) in patients with emergence delirium versus 268/575 (47 %) without: unadjusted hazard ratio 1.06 (95 % CI: 0.87 to 1.29); P = 0.563; adjusted hazard ratio 0.98 (95 % CI: 0.80 to 1.21); P = 0.875.

Conclusions

We did not find significant association between emergence delirium and worse long-term survival in older patients after general anesthesia and major surgery mainly for cancer. The effects of emergence delirium on long-term outcomes deserve further investigation.

Clinical trial registrations: www.chictr.org.cn; ChiCTR-OOC-17012734.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.