Interactive CardioVascular and Thoracic Surgery 0 (2012) 1–7
Wijnand A.C. Palmbergena, Agnes van Sonderena, Ali M. Keyhan-Falsafib, Ruud W.M. Keunena,*and Ron Wolterbeekc
a Department of Neurology and Clinical Neurophysiology, Haga Teaching Hospitals, The Hague, The Netherlands
b Department of Cardiosurgery, Haga Teaching Hospitals, The Hague, The Netherlands
c Department of Medical Statistics and Bioinformatics, Leiden, The Netherlands
* Corresponding author. Department of Neurology, Haga Teaching Hospitals, Leyweg 275, 2545 CH The Hague, The Netherlands. Tel: +31-70-2100000;
e-mail: r.keunen@hagaziekenhuis.nl (R.W.M. Keunen).
Abstract
OBJECTIVES: Postoperative delirium is a major cause of morbidity and mortality after cardiovascular surgery. Risk factors for postoperative
delirium include poor cerebral haemodynamics and perioperative cerebral desaturations. Our aim was to reduce the postoperative
delirium rate by using a new prevention strategy called the Haga Brain Care Strategy. This study evaluates the efficacy of the implementation of the Haga Brain Care Strategy to reduce the postoperative delirium rate after elective coronary artery bypass graft (CABG) procedures. The primary endpoint was the postoperative delirium rate, and the secondary endpoint was the length of stay in the intensive care unit.
METHODS: The Haga Brain Care Strategy consisted of the conventional screening protocol for delirium with the addition of preoperative transcranial Doppler examinations, perioperative cerebral oximetry, modified Rankin score, delirium risk score and (if indicated)
duplex examination of the carotid arteries. In case of poor preoperative haemodynamics, the cerebral blood flow was optionally optimized by angioplasty or the patient was operated on under mild hypothermic conditions. Perioperative cerebral desaturations >20%
outside the normal range resulted in intervention to restore cerebral oxygenation. Cerebral oximetry was discontinued when patients
regained consciousness. Patients undergoing elective CABG procedures in 2010 were compared with patients scheduled for coronary bypass graft procedures in 2009 who had not been exposed to additional Haga Brain Care Strategy assessment.
RESULTS: A total of 233 and 409 patients were included in 2009 and 2010, respectively. The number of patients subjected in 2010 to
transcranial Doppler examinations, cerebral oximetry or both (Haga Brain Care Strategy) were 262 (64.1%), 201 (49.1%) and 139
(34.0%), respectively. The overall rate of postoperative delirium decreased from 31 (13.3%) in 2009 to 30 (7.3%) in 2010 (P = 0.019).
A binary logistic regression model showed that the Haga Brain Care Strategy was an independent predictor of a reduced risk of developing
a postoperative delirium (odd ratio = 0.37, P = 0.021).
CONCLUSIONS: With the implementation of the Haga Brain Care Strategy in 2010, a reduction of the incidence of postoperative delirium
in patients undergoing elective CABG procedures was observed. In addition, the length of stay in the intensive care unit showed an overall tendency to decline. The limited number of observations and the current study design do not allow a full evaluation of the Haga Brain Care Strategy but the data support the idea that a sophisticated preoperative assessment of cerebral haemodynamics and perioperative monitoring of cerebral oximetry reduce the incidence of the postoperative delirium in CABG surgery.
摘要：
目的：術(shù)后刺激性是心血管手術(shù)后發(fā)病和死亡的主要原因。術(shù)后危險(xiǎn)因素?zé)┰瓴话舶ú涣嫉哪X血流動(dòng)力學(xué)和圍手術(shù)期腦去飽和。我們的目標(biāo)是減少術(shù)后通過使用稱Haga Brain Care Strategy的新預(yù)防策略來提高妄想率。這項(xiàng)研究評(píng)估了Haga的腦部護(hù)理策略可降低選擇性冠狀動(dòng)脈搭橋手術(shù)（CABG）后的失率率。主要終點(diǎn)為術(shù)后del妄發(fā)生率，次要終點(diǎn)為重癥監(jiān)護(hù)室住院時(shí)間。
方法：Haga的大腦健康策略包括常規(guī)的del篩查測試，術(shù)前經(jīng)顱多普勒檢查，圍手術(shù)期腦血氧飽和度，改良的Rankin評(píng)分，del發(fā)生ium妄的風(fēng)險(xiǎn)和（如有）仔細(xì)檢查頸動(dòng)脈。如果術(shù)前血流動(dòng)力學(xué)較差，則可以使用血管成形術(shù)來優(yōu)化腦血流量，或者可以在輕度低溫下對(duì)患者進(jìn)行手術(shù)。圍手術(shù)期腦去飽和度> 20％超出正常范圍將導(dǎo)致干預(yù)以恢復(fù)腦氧合。在患者期間停止腦血氧飽和度測量喚醒。將2010年接受CABG擇期手術(shù)的患者與計(jì)劃于2009年接受冠狀動(dòng)脈搭橋手術(shù)的患者（不進(jìn)行額外的Haga腦保健策略評(píng)估）進(jìn)行比較。
結(jié)果：2009年和2010年分別招募了233和409例患者。 2010年接受治療的患者人數(shù)經(jīng)顱多普勒檢查，腦血氧飽和度檢查或兩者（Haga腦部護(hù)理策略）分別為262（64.1％），201（49.1％）和139（34.0％）。術(shù)后非理性的總發(fā)生率從2009年的31（13.3％）下降到2010年的30（7.3％）（P = 0.019）。二元邏輯回歸模型表明，Haga腦部護(hù)理策略是降低疾病風(fēng)險(xiǎn)的獨(dú)立預(yù)測因子手術(shù)后出現(xiàn)煩躁（奇數(shù)比= 0.37，P = 0.021）。
結(jié)論：隨著2010年Haga的腦部護(hù)理策略的實(shí)施，術(shù)后ir妄的發(fā)生率降低了在接受選擇性CABG手術(shù)的患者中觀察到。此外，重癥監(jiān)護(hù)室的住院時(shí)間一般呈下降趨勢。有限的觀察結(jié)果和當(dāng)前的研究設(shè)計(jì)不能完全評(píng)估Haga的大腦健康策略，但數(shù)據(jù)支持這樣的想法，即術(shù)前對(duì)腦血流動(dòng)力學(xué)的精確評(píng)估和圍手術(shù)期對(duì)血氧飽和度的監(jiān)測可以減少手術(shù)后受傷的發(fā)生率。 CABG手術(shù)。（譯文來自GOOGLE)
