Incidence of Delirium and Cognition Changes in Patients Undergoing Elective CABG Surgery

• Main Authors: Hsiu-Ching Li, 李秀卿
• Other Authors: Chia-Hui Chen
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/43502125494296377110

碩士 === 國立臺灣大學 === 護理學研究所 === 99 === Delirium is common after cardiac surgery. The aims of this study were to evaluate: 1) the incidence of delirium one week after Coronary Artery Bypass Graft Surgery (CABG); and 2) changes of cognitive function at discharge and 2-4 weeks following hospitalization in patients underwent CABG surgery. We enrolled 38 patients from July to November, 2010 who scheduled for an elective CABG in a tertiary medical center in northern Taiwan. Delirium was assessed daily by the confusion assessment method (CAM) or ICU-CAM one week after CABG. Demographics and clinical factors were also collected as covariates. Changes of cognitive function were assessed by the mini-mental state examination (MMSE) at three time points: admission, discharge, and 2-4 weeks after discharge. The data were analyzed by the SPSS software package and p value <0.05 was considered significant. The results showed that delirium occurred in 18.4% (n=7) of the sample. For patients undergoing CABG with CPB (Cardiac Pumonary Bypass), the incidence was significantly higher to 45.5%. Overall, time to onset of delirium was on day one postoperatively; the duration of delirium was one day with the maximum up to four days long. Five risk factors including age (71.2 v.s 60.4 years; Z =- 2.2; P = 0.03), CABG with CPB (X2 = 7.9; P = 0.01), intra-operative/postoperative blood transfusion (X2 = 8.6; P = 0.008) , amounts of intra-operative/postoperative blood transfusion﹙Z=－3.5; P=0.000＜0.05﹚and duration time of intra-operative mean blood pressure＜60 mmHg﹙Z=－2.7; P=0.008＜0.05﹚were significantly associated with incidence of delirium. Patients who experienced delirium had lower cognitive function than non-delirium group at three time points (admission, discharge, and 2-4 weeks after discharge) with the between group difference as large as 5.3 MMSE points by hospital discharge (Z =- 1.9, P = 0.049). These findings suggested that delirium after CABG is common and justification was provided for intervention trials to evaluate whether delirium prevention or treatment strategies might reduce incidence and duration of delirium and improve postoperative cognitive function, particularly for those who had multiple susceptibility and precipitating risk factors.