ObjectiveTo investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.MethodsA prospective study was conducted. Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research. All patients were operated by the same group of surgeons and anesthesiologists. Patients in the experimental group received intravenous infusion of 10% fish fat emulsion (Ewing) 100 mL daily from the first day after operation extra to routine treatment; patients in the control group received routine treatment after operation. The postoperative delirium, inflammation, complications, hospital stay, andre-admission on 30 days were compared between the two groups.ResultsA total of 205 patients were under research. The results were as follows. ① There were 47 delirium patients in the control group and 22 delirium patients in the experimental group. The difference between the two groups was statistically significant (P<0.001). There were 32 cases and 19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation; there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation, respectively. The difference was considered statistically significant (P<0.05). ② Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3rd and 7th day after operation, including count of WBC, C-reactive protein, interleukin-6, tumor necrosis factor-α, and platelet crit, and the difference were statistically significant (P<0.05). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group ［(8±1) d vs. (9±2) d］. The difference was considered statistically significant (P<0.01).Conclusionω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.
ObjectiveTo analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium).MethodsWe conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019.ResultsA total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032).ConclusionHypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.
Objective To investigate the evaluation, risk factors and intervening measures of postoperative delirium in patients after liver transplantation, and to provide reference for clinical practice. Methods The relevant literatures on delirium after liver transplantation at home and abroad in recent years were consulted. Based on the definition of postoperative delirium, the research status, evaluation tools and evaluation frequency at home and abroad were reviewed. From the aspects of donor and recipient, the influencing factors by connecting preoperative, intraoperative and postoperative stages and angles were explored. Results The incidence of postoperative delirium in patients with liver transplantation was high, and the risk factors were numerous, which ran through before and after liver transplantation. In terms of research type, most domestic and foreign studies were retrospective, single center, small sample surveys, with different assessment tools and assessment frequency. There were few high-quality intervention studies on delirium after liver transplantation. Conclusions Delirium after liver transplantation is predictable, evaluable and treatable. Effective risk assessment and screening are very important. Intervention for patients undergoing liver transplantation who develop postoperative delirium requires a combination of pharmacologic and non-pharmacologic interventions.
Objective To investigate the prevalence of postoperative delirium (POD) in elderly patients undergoing major orthopedic surgery and analyze its influencing factors, so as to provide evidence for early screening and intervention of POD. Methods The medical records of elderly patients undergoing major orthopedic surgery in the Department of Orthopaedics of the First Medical Center, Chinese PLA General Hospital between January 2021 and December 2022 were retrospectively collected. The included patients were divided into POD group and non-POD group. The patients’ demographic characteristics, medical history, laboratory indicators, perioperative medication, intraoperative and postoperative indicators were collected to analyze the risk factors affecting POD. Results A total of 455 elderly patients were included. Among them, there were 75 cases in the POD group and 380 cases in the non-POD group. The incidence of POD was 16.5% (75/455). There were statistically significant differences in age, body mass index, number of combined underlying diseases≥3, albumin<35 g/L, American Society of Anesthesiologists (ASA) classification, intraoperative blood loss≥200 mL, intraoperative blood transfusion, postoperative Visual Analogue Scale (VAS) score, indwelling catheters, admission to intensive care unit (ICU), and length of ICU stay between the two groups (P<0.05). The results of logistic regression analysis showed that age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU (P<0.05) were independent influencing factors for POD occurrence in elderly patients undergoing major orthopedic surgery. Conclusions POD is one of the common postoperative complications in elderly patients undergoing major orthopedic surgery. Age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU are independent risk factors for POD in elderly patients undergoing major orthopedic surgery. Clinical staff should evaluate and screen these factors early and take preventive measures to reduce the incidence of POD.
Objective To analyze the influencing factors of delirium after endovascular aortic repair (EAR) and to provide evidence for clinical nursing and prevention of this disease. Methods Patients who underwent EAR at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected and assessed for postoperative delirium by Nursing Delirium Screening Scale (Nu-DESC). Nu-DESC score≥3 was divided into a delirium group (a case group), the non-delirium patients with the same operation and adjacent operation sequence were selected, and the ratio of 1∶4 was included in a non-delirium group (a control group). The clinical data between the two groups were compared by univariate analysis, and the significant risk factors in the univariate analysis were analyzed by multivariate logistic regression to determine the influencing factors of postoperative delirium. And stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and abdominal aortic repair (EVAR). Results A total of 213 patients were included in this study, including 46 patients in the case group and 167 patients in the control group. The mean age was 60.3±12.0 years, and 183 (85.9%) patients were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, operation duration, intubation duration, and ICU duration may be associated with postoperative delirium. Multivariate analysis showed that the longer the duration of surgery and intubation, the more likely the patient was to develop delirium. In stratified analyses, the results were consistent with the general population in the TEVAR group, while no significant difference was found in the EVAR group. Conclusion The longer the operation time and tracheal intubation time are, the more prone to delirium patients undergoing TEVAR surgery are. While EVAR patients have no significant difference.
ObjectiveTo investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. MethodsClinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. ResultsA total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ2=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.
ObjectiveTo systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. MethodsWe searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. ResultsA total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=−79.52, 95%CI −125.80 to −33.24, P=0.000 8), blood oxygen saturation (MD=−3.50, 95%CI −4.49 to −2.51, P＜0.000 01), postoperative hemoglobin (MD=−6.35, 95%CI −9.21 to −3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. ConclusionThe current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.
ObjectiveTo explore the relevant risk factors for postoperative delirium (POD) in elderly patients undergoing radical colon cancer surgery, and provide a basis for formulating postoperative prevention and treatment measures for POD. MethodsA total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People’s Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects. Patients were divided into two groups according to the score of Delirium Assessment Scale (4AT Scale). The basic data, main perioperative clinical data and laboratory indicators of the two groups were collected, and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation. ResultsAccording to the results of the 4AT scale score, a total score of ≥4 points was used as the threshold for determining patient POD. Among 128 patients, there were 29 patients (22.66%) with POD and 99 patients (77.34%) without POD. ① General data comparison: There was no significant difference between the two groups in gender, body mass index, years of education, hypertension, diabetes, smoking history and drinking history (P>0.05), but there was significant difference in age, preoperative mini-mental state examination (MMSE) score and American Society of Anesthesiologists (ASA) grade (P<0.05). ② Comparison of main clinical data during the perioperative period: There was no statistically significant difference between the two groups of patients in ICU treatment, nonsteroidal anti-inflammatory drug treatment, visual analogue scale, and intraoperative hypotension (P>0.05), but there was a statistically significant difference in operative time, anesthesia time, intraoperative blood loss, and dexmedetomidine treatment (P<0.05). ③ Comparison of preoperative laboratory indicators: There was no statistically significant difference between the two groups of patients in terms of hemoglobin, serum albumin, white blood cell count, prognostic nutritional index, neutrophil/lymphocyte ratio, D-dimer, and albumin to fibrinogen ratio (P>0.05). ④ The results of logistic regression analysis showed that low preoperative MMSE score [OR=0.397, 95%CI (0.234, 0.673)], long surgical time [OR=1.159, 95%CI (1.059, 1.267) ], and long anesthesia time [OR=1.138, 95%CI (1.057, 1.226) ] were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery. ConclusionPreoperative MMSE score, operative time, and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery, worth implementing key perioperative management in clinical practice to prevent and manage POD.