麻醉与心脏手术后谵妄研究进展
Research Progress of Anesthesia and Delirium after Heart Surgery
DOI: 10.12677/acm.2025.151137, PDF,   
作者: 刘 峰:延安大学医学院,陕西 延安;空军军医大学第二附属医院麻醉科,陕西 西安;路雯珺, 陶 蕾, 喻 倩, 高昌俊, 孙绪德*:空军军医大学第二附属医院麻醉科,陕西 西安;肖志彬:空军第986医院麻醉科,陕西 西安
关键词: 术后谵妄麻醉心脏外科手术术中管理Postoperative Delirium Anesthesiology Cardiac Surgery Intraoperative Management
摘要: 伴随人口老龄化,心血管疾病发病率逐年增长,接受心脏外科手术的患者日益增加。谵妄,是心脏手术后常见的并发症,其发生率高、住院及ICU停留时间延长、死亡率高,给患者和家属带来沉重的负担,因此越来越受到麻醉、外科、ICU及护理等多学科的广泛重视。现代麻醉学,正在向围术期医学迈进,麻醉医生需承担术前、术中及术后多重角色。本文从麻醉学角度对心脏术后谵妄最新定义及其研究进展进行探讨,为广大麻醉医师预防/减少心脏术后谵妄的发生做好术前准备、术中防范和术后镇痛等工作提供更好的理论依据与指导。
Abstract: The incidence of cardiovascular disease and the number of patients undergoing cardiac surgery have increased year by year as the aging population developed. Delirium, characterized by high incidence, prolonged time in hospital and ICU, and high mortality, is a common complication after cardiac surgery, which brings a heavy burden to patients and their family members. Therefore, it has captured more and more attention from many subjects, such as anesthesiology, ICU, surgery and nursing. Modern anesthesiology is moving towards perioperative medicine, and it is necessary for the anesthesiologist to undertake multiple roles in preoperation, intraoperation and postoperation. In this review, we illuminate the latest definition and research progress of postoperative delirium from the point of view of anesthesiology to provide a better theoretical basis and guidance for general anesthesiologists in regard to preoperative preparation, intraoperative prevention and postoperative analgesia.
文章引用:刘峰, 路雯珺, 肖志彬, 陶蕾, 喻倩, 高昌俊, 孙绪德. 麻醉与心脏手术后谵妄研究进展[J]. 临床医学进展, 2025, 15(1): 1026-1031. https://doi.org/10.12677/acm.2025.151137

参考文献

[1] Aldecoa, C., Bettelli, G., Bilotta, F., et al. (2024) Update of the European Society of Anaesthesiology and Intensive Care Medicine Evidence-Based and Consensus-Based Guideline on Postoperative Delirium in Adult Patients. European Journal of Anaesthesiology, 41, 81-108.
[2] Brown, C.H. (2014) Delirium in the Cardiac Surgical ICU. Current Opinion in Anaesthesiology, 27, 117-122. [Google Scholar] [CrossRef] [PubMed]
[3] Evered, L., Silbert, B., Knopman, D.S., Scott, D.A., DeKosky, S.T., Rasmussen, L.S., et al. (2018) Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery—2018. Canadian Journal of Anesthesia/Journal canadien danesthésie, 65, 1248-1257. [Google Scholar] [CrossRef] [PubMed]
[4] Varpaei, H.A., Robbins, L.B., Ling, J., Lehto, R.H. and Bender, C.M. (2023) Anaesthesia‐Related Cognitive Dysfunction Following Cardiothoracic Surgery in Late Middle‐Age and Younger Adults: A Scoping Review. Nursing in Critical Care, 29, 457-465. [Google Scholar] [CrossRef] [PubMed]
[5] Chang, B., Lorenzo, J. and Macario, A. (2015) Examining Health Care Costs. Anesthesiology Clinics, 33, 753-770. [Google Scholar] [CrossRef] [PubMed]
[6] Lipp, M., Schneider, G., Kreuzer, M. and Pilge, S. (2023) Substance-Dependent EEG during Recovery from Anesthesia and Optimization of Monitoring. Journal of Clinical Monitoring and Computing, 38, 603-612. [Google Scholar] [CrossRef] [PubMed]
[7] McPherson, J.A., Wagner, C.E., Boehm, L.M., Hall, J.D., Johnson, D.C., Miller, L.R., et al. (2013) Delirium in the Cardiovascular ICU. Critical Care Medicine, 41, 405-413. [Google Scholar] [CrossRef] [PubMed]
[8] Hosker, C. and Ward, D. (2017) Hypoactive Delirium. BMJ, 357, j2047. [Google Scholar] [CrossRef] [PubMed]
[9] Brown, C.H., Probert, J., Healy, R., Parish, M., Nomura, Y., Yamaguchi, A., et al. (2018) Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery. Anesthesiology, 129, 406-416. [Google Scholar] [CrossRef] [PubMed]
[10] Robinson, T.N. (2011) Motor Subtypes of Postoperative Delirium in Older Adults. Archives of Surgery, 146, 295-300. [Google Scholar] [CrossRef] [PubMed]
[11] Nomi, T., Kaibori, M., Hirokawa, F., Ueno, M., Hokuto, D., Noda, T., et al. (2023) Effect of Laparoscopic Liver Resection on Postoperative Delirium in Elderly Patients with Hepatocellular Carcinoma. Journal of Hepato-Biliary-Pancreatic Sciences, 30, 1111-1118. [Google Scholar] [CrossRef] [PubMed]
[12] Au, E., Thangathurai, G., Saripella, A., Yan, E., Englesakis, M., Nagappa, M., et al. (2023) Postoperative Outcomes in Elderly Patients Undergoing Cardiac Surgery with Preoperative Cognitive Impairment: A Systematic Review and Meta-analysis. Anesthesia & Analgesia, 136, 1016-1028. [Google Scholar] [CrossRef] [PubMed]
[13] Pappachan, B. and Agrawal, R. (2018) Post-Operative Delirium. Journal of Maxillofacial and Oral Surgery, 18, 157-158. [Google Scholar] [CrossRef] [PubMed]
[14] Tian, Y., Ji, B., Diao, X., Wang, C., Wang, W., Gao, Y., et al. (2023) Dynamic Predictive Scores for Cardiac Surgery-Associated Agitated Delirium: A Single-Center Retrospective Observational Study. Journal of Cardiothoracic Surgery, 18, Article No. 219. [Google Scholar] [CrossRef] [PubMed]
[15] Chen, H., Mo, L., Hu, H., Ou, Y. and Luo, J. (2021) Risk Factors of Postoperative Delirium after Cardiac Surgery: A Meta-Analysis. Journal of Cardiothoracic Surgery, 16, Article No. 113. [Google Scholar] [CrossRef] [PubMed]
[16] Oliveira, F.R., Oliveira, V.H., Oliveira, Í.M., Lima, J.W., Calderaro, D., Gualandro, D.M., et al. (2018) Hypertension, Mitral Valve Disease, Atrial Fibrillation and Low Education Level Predict Delirium and Worst Outcome after Cardiac Surgery in Older Adults. BMC Anesthesiology, 18, Article No. 15. [Google Scholar] [CrossRef] [PubMed]
[17] Styra, R., Larsen, E., Dimas, M.A., Baston, D., Elgie-Watson, J., Flockhart, L., et al. (2019) The Effect of Preoperative Cognitive Impairment and Type of Vascular Surgery Procedure on Postoperative Delirium with Associated Cost Implications. Journal of Vascular Surgery, 69, 201-209. [Google Scholar] [CrossRef] [PubMed]
[18] Ogawa, M., Izawa, K.P., Satomi-Kobayashi, S., Kitamura, A., Tsuboi, Y., Komaki, K., et al. (2017) Preoperative Exercise Capacity Is Associated with the Prevalence of Postoperative Delirium in Elective Cardiac Surgery. Aging Clinical and Experimental Research, 30, 27-34. [Google Scholar] [CrossRef] [PubMed]
[19] Ringaitienė, D., Gineitytė, D., Vicka, V., Žvirblis, T., Šipylaitė, J., Irnius, A., et al. (2015) Impact of Malnutrition on Postoperative Delirium Development after on Pump Coronary Artery Bypass Grafting. Journal of Cardiothoracic Surgery, 10, Article No. 74. [Google Scholar] [CrossRef] [PubMed]
[20] Omiya, H., Yoshitani, K., Yamada, N., Kubota, Y., Takahashi, K., Kobayashi, J., et al. (2015) Preoperative Brain Magnetic Resonance Imaging and Postoperative Delirium after Off-Pump Coronary Artery Bypass Grafting: A Prospective Cohort Study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 62, 595-602. [Google Scholar] [CrossRef] [PubMed]
[21] Mariscalco, G., Cottini, M., Zanobini, M., Salis, S., Dominici, C., Banach, M., et al. (2012) Preoperative Statin Therapy Is Not Associated with a Decrease in the Incidence of Delirium after Cardiac Operations. The Annals of Thoracic Surgery, 93, 1439-1447. [Google Scholar] [CrossRef] [PubMed]
[22] Lee, D., Lee, M.Y., Park, C., Kim, D., Kim, Y. and Park, Y. (2018) Preoperative Statins Are Associated with a Reduced Risk of Postoperative Delirium Following Vascular Surgery. PLOS ONE, 13, e0192841. [Google Scholar] [CrossRef] [PubMed]
[23] Vollmer, N.J., Wieruszewski, E.D., Nei, A.M., Mara, K.C., Rabinstein, A.A. and Brown, C.S. (2024) Impact of Continuous Infusion Ketamine Compared to Continuous Infusion Benzodiazepines on Delirium in the Intensive Care Unit. Journal of Intensive Care Medicine, 39, 1204-1211. [Google Scholar] [CrossRef] [PubMed]
[24] Wu, M., Liang, Y., Dai, Z. and Wang, S. (2018) Perioperative Dexmedetomidine Reduces Delirium after Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Anesthesia, 50, 33-42. [Google Scholar] [CrossRef] [PubMed]
[25] Siripoonyothai, S. and Sindhvananda, W. (2021) Comparison of Postoperative Delirium within 24 Hours between Ketamine and Propofol Infusion during Cardiopulmonary Bypass Machine: A Randomized Controlled Trial. Annals of Cardiac Anaesthesia, 24, 294-301. [Google Scholar] [CrossRef] [PubMed]
[26] Avidan, M.S., Maybrier, H.R., Abdallah, A.B., Jacobsohn, E., Vlisides, P.E., Pryor, K.O., et al. (2017) Intraoperative Ketamine for Prevention of Postoperative Delirium or Pain after Major Surgery in Older Adults: An International, Multicentre, Double-Blind, Randomised Clinical Trial. The Lancet, 390, 267-275. [Google Scholar] [CrossRef] [PubMed]
[27] Royse, C.F., Saager, L., Whitlock, R., Ou-Young, J., Royse, A., Vincent, J., et al. (2017) Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial. Anesthesiology, 126, 223-233. [Google Scholar] [CrossRef] [PubMed]
[28] Sauër, A.C., Slooter, A.J.C., Veldhuijzen, D.S., van Eijk, M.M.J., Devlin, J.W. and van Dijk, D. (2014) Intraoperative Dexamethasone and Delirium after Cardiac Surgery. Anesthesia & Analgesia, 119, 1046-1052. [Google Scholar] [CrossRef] [PubMed]
[29] Luo, C. and Zou, W. (2018) Cerebral Monitoring of Anaesthesia on Reducing Cognitive Dysfunction and Postoperative Delirium: A Systematic Review. Journal of International Medical Research, 46, 4100-4110. [Google Scholar] [CrossRef] [PubMed]
[30] Whitlock, E.L., Torres, B.A., Lin, N., Helsten, D.L., Nadelson, M.R., Mashour, G.A., et al. (2014) Postoperative Delirium in a Substudy of Cardiothoracic Surgical Patients in the BAG-RECALL Clinical Trial. Anesthesia & Analgesia, 118, 809-817. [Google Scholar] [CrossRef] [PubMed]
[31] Fritz, B.A., Maybrier, H.R. and Avidan, M.S. (2018) Intraoperative Electroencephalogram Suppression at Lower Volatile Anaesthetic Concentrations Predicts Postoperative Delirium Occurring in the Intensive Care Unit. British Journal of Anaesthesia, 121, 241-248. [Google Scholar] [CrossRef] [PubMed]
[32] Ling, L., Yang, T.X. and Lee, S.W.K. (2022) Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis. Cureus, 14, e30120. [Google Scholar] [CrossRef] [PubMed]
[33] Gutierrez, R.D., Pepic, L., Lancaster, E.M., Gasper, W.J., Hiramoto, J.S., Conte, M.S., et al. (2024) Early Opioid Use and Postoperative Delirium Following Open Abdominal Aortic Aneurysm Repair. Annals of Vascular Surgery, 109, 338-349. [Google Scholar] [CrossRef] [PubMed]
[34] Mondal, S., Bergbower, E.A.S., Cheung, E., Grewal, A.S., Ghoreishi, M., Hollander, K.N., et al. (2023) Role of Cardiac Anesthesiologists in Intraoperative Enhanced Recovery after Cardiac Surgery (ERACS) Protocol: A Retrospective Single-Center Study Analyzing Preliminary Results of a Yearlong ERACS Protocol Implementation. Journal of Cardiothoracic and Vascular Anesthesia, 37, 2450-2460. [Google Scholar] [CrossRef] [PubMed]
[35] Indja, B., Seco, M., Seamark, R., Kaplan, J., Bannon, P.G., Grieve, S.M., et al. (2017) Neurocognitive and Psychiatric Issues Post Cardiac Surgery. Heart, Lung and Circulation, 26, 779-785. [Google Scholar] [CrossRef] [PubMed]
[36] Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R.D., Audisio, R., Borozdina, A., et al. (2017) European Society of Anaesthesiology Evidence-Based and Consensus-Based Guideline on Postoperative Delirium. European Journal of Anaesthesiology, 34, 192-214. [Google Scholar] [CrossRef] [PubMed]
[37] Cherry, A. and Aronson, S. (2013) The Future of Cardiothoracic Anesthesia. Anesthesiology Clinics, 31, 207-216. [Google Scholar] [CrossRef] [PubMed]