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.	刘胜中, 丛伟, 甘崇志, 等.体外循环心脏直视手术后并发精神障碍的临床分析.中国胸心血管外科临床杂志, 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.	吕春梅, 李杏崧, 莫韶妹, 等. ICU谵妄患者分型护理干预效果观察.当代护士, 2012, 7:115-117.
8.	苏云术, 徐利军, 魏翔.心脏术后谵妄的原因分析与处理对策.广州医学院学报, 2013, 41(4):94-96.
9.	刘威, 齐娟, 于荣国, 等.体外循环术中局部脑氧饱和度与术后谵妄的关系.福建医科大学学报, 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, Rothenhäusler 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.	邹姮婧, 梅伟, 张传汉, 等.重症监护谵妄评定方法在术后患者中使用的信度和效度检验.中华行为医学与脑科学杂志, 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.	穆东亮, 王东信, 李立环, 等.冠状动脉旁路移植手术后早期谵妄与认知功能障碍的关系.北京大学学报:医学版, 2011, 43(2):242-249.
25.	王儒林, 杨晓军, 马玉杰, 等.中文版重症监护谵妄筛查量表评估ICU谵妄患者的临床研究.中国实用护理杂志, 2013, 29(30):12-14.
26.	刘尚昆, 梅伟, 张治国, 等.重症监护谵妄筛查量表在麻醉苏醒期患者中使用的信效度分析.护理学杂志, 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.	梅伟, 刘尚昆, 张治国, 等.中文版护理谵妄筛查量表的信度和效度研究.中华护理杂志, 2010, 45(2):101-104.
29.	Lingehall HC, Smulter N, Engström 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.	李颖, 许卫江, 刘彬.右美托咪定在心脏术后兴奋型谵妄治疗中的应用价值.实用临床医药杂志, 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.老年人心脏术后谵妄的护理研究进展.中国实用护理杂志, 2012, 28(z2):67.
38.	张伟英, 孙燕, 叶文琴.冠状动脉旁路移植术后谵妄的研究进展.中华护理杂志, 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.	罗德生, 王慧, 方敏, 等.术前访视对预防心脏外科术后患者ICU综合征的效果观察.护理实践与研究, 2012, 9(2):36-37.

1. 刘胜中, 丛伟, 甘崇志, 等.体外循环心脏直视手术后并发精神障碍的临床分析.中国胸心血管外科临床杂志, 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. 吕春梅, 李杏崧, 莫韶妹, 等. ICU谵妄患者分型护理干预效果观察.当代护士, 2012, 7:115-117.
8. 苏云术, 徐利军, 魏翔.心脏术后谵妄的原因分析与处理对策.广州医学院学报, 2013, 41(4):94-96.
9. 刘威, 齐娟, 于荣国, 等.体外循环术中局部脑氧饱和度与术后谵妄的关系.福建医科大学学报, 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, Rothenhäusler 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. 邹姮婧, 梅伟, 张传汉, 等.重症监护谵妄评定方法在术后患者中使用的信度和效度检验.中华行为医学与脑科学杂志, 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. 穆东亮, 王东信, 李立环, 等.冠状动脉旁路移植手术后早期谵妄与认知功能障碍的关系.北京大学学报:医学版, 2011, 43(2):242-249.
25. 王儒林, 杨晓军, 马玉杰, 等.中文版重症监护谵妄筛查量表评估ICU谵妄患者的临床研究.中国实用护理杂志, 2013, 29(30):12-14.
26. 刘尚昆, 梅伟, 张治国, 等.重症监护谵妄筛查量表在麻醉苏醒期患者中使用的信效度分析.护理学杂志, 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. 梅伟, 刘尚昆, 张治国, 等.中文版护理谵妄筛查量表的信度和效度研究.中华护理杂志, 2010, 45(2):101-104.
29. Lingehall HC, Smulter N, Engström 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. 李颖, 许卫江, 刘彬.右美托咪定在心脏术后兴奋型谵妄治疗中的应用价值.实用临床医药杂志, 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.老年人心脏术后谵妄的护理研究进展.中国实用护理杂志, 2012, 28(z2):67.
38. 张伟英, 孙燕, 叶文琴.冠状动脉旁路移植术后谵妄的研究进展.中华护理杂志, 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. 罗德生, 王慧, 方敏, 等.术前访视对预防心脏外科术后患者ICU综合征的效果观察.护理实践与研究, 2012, 9(2):36-37.

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