Study On Influencing Factors Of Postoperative Delirium In Elder Surgical Intensive Care Unit Patients

Objective: Analyzing the influencing factors of postoperative delirium in elder surgical ICU patients were to provide basis for identifying and predicting senile patients at high risk of postoperative delirium and formulating relevant preventive measures.Method: A case-control study was used.We selected the elderly patients who were transferred to the surgical ICU of a third-grade grade A hospital in Shenyang from October 2021 to November 2022 for postoperative delirium.According to the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for The Intensive Care Unit,postoperative delirium was determined.70 patients in the case group and 182 patients in the control group were divided according to the occurrence of postoperative delirium.The self-designed preliminary screening table of influencing factors of postoperative delirium in critically ill elderly surgical patients,Richmond agitation and sedation score,acute physiological and chronic health scoreⅡ,and Chinese version of ICU pain observation tool were used as research tools.The influencing factors of postoperative delirium in elderly patients in intensive care were determined by univariate analysis and multivariate Logistic regression analysis by using the indicators we have collected.Results: 1.Among the 70 elderly patients with postoperative delirium,36 patients had hyperactive delirium,accounting for 51.43%.Activity suppression delirium occurred in 13 patients 18.57%.Mixed delirium occurred in 21 patients,accounting for 30%.2.The results of univariate analysis show that: Age,education,drinking history,emergency operation,operation duration,mechanical ventilation duration,SICU hospitalization duration,use of nalbuphine,propofel,midazolam,24 h postoperative blood transfusion >1L,hypoxemia,hypoproteinemia,leukocyte >10*10^9/L,APACHEⅡ score,CPOT score in postoperative delirium group and non-postoperative delirium group have statistical difference(P < 0.05).3.The results of multivariate Logistic regression analysis showed that: Drinking history is a risk factor for postoperative delirium in elderly patients,(OR =1.62,95%CI[1.175～21.530]),length of hospitalization of SICU was a risk factor for postoperative delirium in elderly patients(OR = 1.025,95%CI[1.571～4.941]),use of nalbuphine was a risk factor for postoperative delirium in elderly patients(OR=5.747,95%CI[15.709～6251.717]),blood transfusion >1L 24 hours after surgery was the risk factor for postoperative delirium in elderly patients(OR = 2.502,95%CI[1.39～107.213]),leukocyte >10*10^9/L was the risk factor for postoperative delirium in elderly patients(OR = 2.24,95%CI[1.341～65.868]),and CPOT score was the risk factor for postoperative delirium in elderly patients(OR = 2.057,95%CI[3.12～19.616]).Education level(middle school,high school or technical secondary school OR=-5.031,95%CI[0～0.113];College OR=-6.814,95%CI[0～0.106]),mechanical ventilation(OR =-0.18,95%CI[0.966～19.0.998])and operation duration(OR =-0.978,95%CI[0.186～0.760])are protective factors for postoperative delirium in elderly patients.Conclusions: History of alcohol consumption,low educational level,mechanical ventilation time,operation time,SICU hospitalization time,use of nalbuphine,blood transfusion >1L 24 hours after surgery,infection and pain are independent risk factors for delirium.Higher education,longer mechanical ventilation and shorter operation duration are protective factors for postoperative delirium in elderly patients.The medical staff in surgical ICU should improve the attention level of postoperative delirium in elderly patients,identify high-risk patients with postoperative delirium as early as possible,take effective intervention measures to prevent postoperative delirium in elderly patients,and shorten the duration of delirium,improve the prognosis of patients with delirium.