医学
谵妄
围手术期
重症监护室
心脏外科
体外循环
麻醉
前瞻性队列研究
重症监护医学
外科
作者
Rita Katznelson,George Djaiani,Michael A. Borger,Zeev Friedman,Susan E. Abbey,Ludwik Fedorko,Jacek Karski,Nicholas Mitsakakis,Jo Carroll,W. Scott Beattie
出处
期刊:Anesthesiology
[Ovid Technologies (Wolters Kluwer)]
日期:2009-01-01
卷期号:110 (1): 67-73
被引量:177
标识
DOI:10.1097/aln.0b013e318190b4d9
摘要
Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Use of statins has been shown to decrease morbidity and mortality after major surgical procedures. The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass.After Institutional Review Board approval, data were prospectively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery. Statins were tested for a potential protective effect.Of the 1,059 patients analyzed, 122 patients (11.5%) had delirium at any time during their cardiovascular intensive care unit stay. Administration of statins had a protective effect, reducing the odds of delirium by 46%. Independent predictors of postoperative delirium included older age, preoperative depression, preoperative renal dysfunction, complex cardiac surgery, perioperative intraaortic balloon pump support, and massive blood transfusion. The model was reliable (Hosmer-Lemeshow test, P = 0.3) and discriminative (area under receiver operating characteristic curve = 0.77).Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.
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