Araştırma Makalesi
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Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi

Yıl 2022, Cilt: 11 Sayı: 1, 11 - 21, 29.04.2022
https://doi.org/10.47493/abantmedj.1067988

Öz

Amaç: Deliryum dikkat ve bilişsel işlevlerde ani başlangıçlı bozulma ile karakterize bir klinik tablodur. Deliryum kliniğinin altında birçok neden yatmakla beraber bazen sadece cerrahi bile kendi başına deliryum tablosu oluşturacak etkiye sahip olabilmektedir. Biz bu çalışmada genel cerrahi kliniğinde opere edilen ve postoperatif takip döneminde deliryum tablosu gelişmesi nedeniyle ruh sağlığı ve hastalıkları kliniğine konsülte edilen hastalarda tedavi yaklaşımlarının retrospektif analizini yapmayı amaçladık.
Yöntem ve Gereçler: Muğla Eğitim ve Araştırma Hastanesi Genel Cerrahi kliniğinde, Ocak 2019- Kasım 2021 tarihleri arasında opere edilen ve postoperatif dönemde deliryum tablosu geliştiği düşünülerek ruh sağlığı ve hastalıkları kliniğine konsülte edilen hastalar çalışmaya dahil edildi.
Bulgular: 38 hastadan 13 (%24,2) si kadın, 25’i (%65,8) erkek idi. Hastaların yaşları değerlendirildiğinde 61,5 (iqr: 45,5-79,25) idi. Operasyon süresi deliryum tablosunda semptomların devam ettiği süreyle ilişkili saptanmıştır (p:0,038). Yoğun bakımda yatış süresinin ve buna ek olarak toplam yatış süresinin uzaması yüksek korelasyon değerleri ile anlamlı olarak ilişkili saptanmıştır (sırasıyla rho:0,852, p<0,001 ve rho:0,866, p<0,001).
Sonuç: Çalışmamıza göre deliryum tablosu gelişen hastalarda semptom sürelerinin uzaması hastalarda yoğun bakım süreleri ve toplam yatış sürelerinin de uzamasıyla ilişkilidir. Yine uzamış operasyon süreleri deliryum tablosunun semptom süreleri ile ilişkili saptanmıştır. Ruh sağlığı ve hastalıkları profesyonellerinin bu hasta grubunu değerlendirmesi, mortalite ve morbidite üzerine önemli etkisi olan bu tablonun erken tanısında önemli rol oynamaktadır.

Kaynakça

  • 1. Burns, A., A. Gallagley, and J. Byrne, Delirium. Journal of Neurology, Neurosurgery & Psychiatry, 2004. 75(3): p. 362-367.
  • 2. Brown, T. and M. Boyle, Delirium. Bmj, 2002. 325(7365): p. 644-647.
  • 3. McDaniel, M. and C. Brudney, Postoperative delirium: etiology and management. Current opinion in critical care, 2012. 18(4): p. 372-376.
  • 4. Langan, C., et al., Psychiatric symptomatology after delirium: a systematic review. Psychogeriatrics, 2017. 17(5): p. 327-335.
  • 5. Hopwood, C.J., A.L. Mulay, and M.H. Waugh, The DSM-5 Alternative Model for Personality Disorders: Integrating multiple paradigms of personality assessment. 2019: Routledge/Taylor & Francis Group.
  • 6. Whitlock, E.L., A. Vannucci, and M.S. Avidan, Postoperative delirium. Minerva anestesiologica, 2011. 77(4): p. 448.
  • 7. Hosie, A., et al., Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliative medicine, 2013. 27(6): p. 486-498.
  • 8. Armstrong, S.C., K.L. Cozza, and K.S. Watanabe, The misdiagnosis of delirium. Psychosomatics, 1997. 38(5): p. 433-439.
  • 9. Maldonado, J.R., Delirium in the acute care setting: characteristics, diagnosis and treatment. Critical care clinics, 2008. 24(4): p. 657-722.
  • 10. Lipowski, Z., Delirium (acute confusional states). Jama, 1987. 258(13): p. 1789-1792.
  • 11. Blass, J. and G. Gibson, Carbohydrates and acetylcholine synthesis: Implications for cognitive disorders, in Brain acetylcholine and neuropsychiatric disease. 1979, Springer. p. 215-236.
  • 12. Gibson, G.E., C. Peterson, and J. Sansone, Neurotransmitter and carbohydrate metabolism during aging and mild hypoxia. Neurobiology of aging, 1981. 2(3): p. 165-172.
  • 13. Hirsch, J.A. and G.E. Gibson, Selective alteration of neurotransmitter release by low oxygen in vitro. Neurochemical research, 1984. 9(8): p. 1039-1049.
  • 14. Yang, F.M., et al., Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics, 2009. 50(3): p. 248-254.
  • 15. Cirbus, J., et al., Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients. International psychogeriatrics, 2019. 31(2): p. 267-276.
  • 16. Inouye, S.K., Predisposing and precipitating factors for delirium in hospitalized older patients. Dementia and geriatric cognitive disorders, 1999. 10(5): p. 393-400.
  • 17. Parikh, S.S. and F. Chung, Postoperative delirium in the elderly. Anesthesia & Analgesia, 1995. 80(6): p. 1223-1232.
  • 18. Kobayashi, K., et al., A retrospective study on delirium type. Psychiatry and Clinical Neurosciences, 1992. 46(4): p. 911-918.
  • 19. Ljubisavljevic, V. and B. Kelly, Risk factors for development of delirium among oncology patients. General hospital psychiatry, 2003. 25(5): p. 345-352.
  • 20. Marcantonio, E.R., et al., Delirium symptoms in post‐acute care: Prevalent, persistent, and associated with poor functional recovery. Journal of the American Geriatrics Society, 2003. 51(1): p. 4-9.
  • 21. Aldemir, M., et al., Predisposing factors for delirium in the surgical intensive care unit. Critical care, 2001. 5(5): p. 1-6.
  • 22. Tan, M.C., et al., Incidence and predictors of post-cardiotomy delirium. The American Journal of Geriatric Psychiatry, 2008. 16(7): p. 575-583.
  • 23. Moskowitz, E.E., et al., Post-operative delirium is associated with increased 5-year mortality. The American Journal of Surgery, 2017. 214(6): p. 1036-1038.
  • 24. Koizumi, J., et al., Duration of delirium shortened by the correction of electrolyte imbalance. Psychiatry and Clinical Neurosciences, 1988. 42(1): p. 81-88.
  • 25. Zieschang, T., et al., The association of hyponatremia, risk of confusional state, and mortality: a prospective controlled longitudinal study in older patients. Deutsches Ärzteblatt International, 2016. 113(50): p. 855.
  • 26. Croxson, M., J. Lucas, and W. Bagg, Diluting delirium. The New Zealand Medical Journal (Online), 2005. 118(1222).
  • 27. Bebarta, V.S., J.A. King, and M. McDonough, Proton pump inhibitor–induced rhabdomyolysis and hyponatremic delirium. The American journal of emergency medicine, 2008. 26(4): p. 519. e1-519. e2.
  • 28. Yıldızeli, B., et al., Factors associated with postoperative delirium after thoracic surgery. The Annals of thoracic surgery, 2005. 79(3): p. 1004-1009.
  • 29. Bryson, G.L. and A. Wyand, Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Canadian Journal of Anesthesia, 2006. 53(7): p. 669.
  • 30. Lee, H., et al., Impact of timing and duration of postoperative delirium: a retrospective observational study. Surgery, 2018. 164(1): p. 137-143.
  • 31. Hein, C., et al., Impact of polypharmacy on occurrence of delirium in elderly emergency patients. Journal of the American Medical Directors Association, 2014. 15(11): p. 850. e11-850. e15.
  • 32. Garpestad, E. and J.W. Devlin, Polypharmacy and delirium in critically ill older adults: recognition and prevention. Clinics in geriatric medicine, 2017. 33(2): p. 189-203.
  • 33. Beresin, E.V., Delirium in the elderly. Topics in geriatrics, 1988. 1(3): p. 127-143.
  • 34. McCusker, J., et al., Environmental risk factors for delirium in hospitalized older people. Journal of the American Geriatrics Society, 2001. 49(10): p. 1327-1334.
  • 35. Farrell, K.R. and L. Ganzini, Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 1995. 155(22): p. 2459-2464.
  • 36. Leslie, D.L., et al., One-year health care costs associated with delirium in the elderly population. Archives of internal medicine, 2008. 168(1): p. 27-32.
  • 37. Kalabalik, J., L. Brunetti, and R. El-Srougy, Intensive care unit delirium: a review of the literature. Journal of pharmacy practice, 2014. 27(2): p. 195-207.
  • 38. Meagher, D., Delirium: the role of psychiatry. Advances in Psychiatric treatment, 2001. 7(6): p. 433-442.

Management of Delirium in Patients Developing Post-Surgical Delirium and Consulted to the Mental Health and Diseases Clinic: A Single Center Experience

Yıl 2022, Cilt: 11 Sayı: 1, 11 - 21, 29.04.2022
https://doi.org/10.47493/abantmedj.1067988

Öz

Objective: Delirium is a clinical picture characterized by sudden onset deterioration in attention and cognitive functions. There are many reasons underlying the delirium clinic; even just surgery can have the effect of creating delirium. In this study, we aimed to make a retrospective analysis of the treatment approaches in patients who were operated in the general surgery clinic and who were consulted to the psychiatry clinic due to the development of delirium during the postoperative follow-up period.
Materials and Methods: Patients who were operated in Muğla Training and Research Hospital General Surgery clinic between January 2019 and November 2021 and who were consulted to the psychiatry clinic considering that delirium developed in the postoperative period were included in the study.
Results: 13(24.2%) of 38 patients were female and 25(65.8%) were male. The median age was 61.5(iqr:45.5-79.25). The duration of the operation was found to be related to the duration of the symptoms in the delirium picture (p:0.038). Total length of stay in the intensive care unit and hospital was found to be associated with the duration of delirium.
Conclusion: The prolongation of the duration of symptoms in patients with delirium is associated with the prolongation of the duration of intensive care and total hospitalization in patients. Again, prolonged operation times were found to be associated with the symptom duration of the delirium. The evaluation of this patient group by psychiatry professionals plays an important role in the early diagnosis of this clinic, which has a significant impact on mortality and morbidity.

Kaynakça

  • 1. Burns, A., A. Gallagley, and J. Byrne, Delirium. Journal of Neurology, Neurosurgery & Psychiatry, 2004. 75(3): p. 362-367.
  • 2. Brown, T. and M. Boyle, Delirium. Bmj, 2002. 325(7365): p. 644-647.
  • 3. McDaniel, M. and C. Brudney, Postoperative delirium: etiology and management. Current opinion in critical care, 2012. 18(4): p. 372-376.
  • 4. Langan, C., et al., Psychiatric symptomatology after delirium: a systematic review. Psychogeriatrics, 2017. 17(5): p. 327-335.
  • 5. Hopwood, C.J., A.L. Mulay, and M.H. Waugh, The DSM-5 Alternative Model for Personality Disorders: Integrating multiple paradigms of personality assessment. 2019: Routledge/Taylor & Francis Group.
  • 6. Whitlock, E.L., A. Vannucci, and M.S. Avidan, Postoperative delirium. Minerva anestesiologica, 2011. 77(4): p. 448.
  • 7. Hosie, A., et al., Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliative medicine, 2013. 27(6): p. 486-498.
  • 8. Armstrong, S.C., K.L. Cozza, and K.S. Watanabe, The misdiagnosis of delirium. Psychosomatics, 1997. 38(5): p. 433-439.
  • 9. Maldonado, J.R., Delirium in the acute care setting: characteristics, diagnosis and treatment. Critical care clinics, 2008. 24(4): p. 657-722.
  • 10. Lipowski, Z., Delirium (acute confusional states). Jama, 1987. 258(13): p. 1789-1792.
  • 11. Blass, J. and G. Gibson, Carbohydrates and acetylcholine synthesis: Implications for cognitive disorders, in Brain acetylcholine and neuropsychiatric disease. 1979, Springer. p. 215-236.
  • 12. Gibson, G.E., C. Peterson, and J. Sansone, Neurotransmitter and carbohydrate metabolism during aging and mild hypoxia. Neurobiology of aging, 1981. 2(3): p. 165-172.
  • 13. Hirsch, J.A. and G.E. Gibson, Selective alteration of neurotransmitter release by low oxygen in vitro. Neurochemical research, 1984. 9(8): p. 1039-1049.
  • 14. Yang, F.M., et al., Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics, 2009. 50(3): p. 248-254.
  • 15. Cirbus, J., et al., Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients. International psychogeriatrics, 2019. 31(2): p. 267-276.
  • 16. Inouye, S.K., Predisposing and precipitating factors for delirium in hospitalized older patients. Dementia and geriatric cognitive disorders, 1999. 10(5): p. 393-400.
  • 17. Parikh, S.S. and F. Chung, Postoperative delirium in the elderly. Anesthesia & Analgesia, 1995. 80(6): p. 1223-1232.
  • 18. Kobayashi, K., et al., A retrospective study on delirium type. Psychiatry and Clinical Neurosciences, 1992. 46(4): p. 911-918.
  • 19. Ljubisavljevic, V. and B. Kelly, Risk factors for development of delirium among oncology patients. General hospital psychiatry, 2003. 25(5): p. 345-352.
  • 20. Marcantonio, E.R., et al., Delirium symptoms in post‐acute care: Prevalent, persistent, and associated with poor functional recovery. Journal of the American Geriatrics Society, 2003. 51(1): p. 4-9.
  • 21. Aldemir, M., et al., Predisposing factors for delirium in the surgical intensive care unit. Critical care, 2001. 5(5): p. 1-6.
  • 22. Tan, M.C., et al., Incidence and predictors of post-cardiotomy delirium. The American Journal of Geriatric Psychiatry, 2008. 16(7): p. 575-583.
  • 23. Moskowitz, E.E., et al., Post-operative delirium is associated with increased 5-year mortality. The American Journal of Surgery, 2017. 214(6): p. 1036-1038.
  • 24. Koizumi, J., et al., Duration of delirium shortened by the correction of electrolyte imbalance. Psychiatry and Clinical Neurosciences, 1988. 42(1): p. 81-88.
  • 25. Zieschang, T., et al., The association of hyponatremia, risk of confusional state, and mortality: a prospective controlled longitudinal study in older patients. Deutsches Ärzteblatt International, 2016. 113(50): p. 855.
  • 26. Croxson, M., J. Lucas, and W. Bagg, Diluting delirium. The New Zealand Medical Journal (Online), 2005. 118(1222).
  • 27. Bebarta, V.S., J.A. King, and M. McDonough, Proton pump inhibitor–induced rhabdomyolysis and hyponatremic delirium. The American journal of emergency medicine, 2008. 26(4): p. 519. e1-519. e2.
  • 28. Yıldızeli, B., et al., Factors associated with postoperative delirium after thoracic surgery. The Annals of thoracic surgery, 2005. 79(3): p. 1004-1009.
  • 29. Bryson, G.L. and A. Wyand, Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Canadian Journal of Anesthesia, 2006. 53(7): p. 669.
  • 30. Lee, H., et al., Impact of timing and duration of postoperative delirium: a retrospective observational study. Surgery, 2018. 164(1): p. 137-143.
  • 31. Hein, C., et al., Impact of polypharmacy on occurrence of delirium in elderly emergency patients. Journal of the American Medical Directors Association, 2014. 15(11): p. 850. e11-850. e15.
  • 32. Garpestad, E. and J.W. Devlin, Polypharmacy and delirium in critically ill older adults: recognition and prevention. Clinics in geriatric medicine, 2017. 33(2): p. 189-203.
  • 33. Beresin, E.V., Delirium in the elderly. Topics in geriatrics, 1988. 1(3): p. 127-143.
  • 34. McCusker, J., et al., Environmental risk factors for delirium in hospitalized older people. Journal of the American Geriatrics Society, 2001. 49(10): p. 1327-1334.
  • 35. Farrell, K.R. and L. Ganzini, Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 1995. 155(22): p. 2459-2464.
  • 36. Leslie, D.L., et al., One-year health care costs associated with delirium in the elderly population. Archives of internal medicine, 2008. 168(1): p. 27-32.
  • 37. Kalabalik, J., L. Brunetti, and R. El-Srougy, Intensive care unit delirium: a review of the literature. Journal of pharmacy practice, 2014. 27(2): p. 195-207.
  • 38. Meagher, D., Delirium: the role of psychiatry. Advances in Psychiatric treatment, 2001. 7(6): p. 433-442.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Meltem Derya Şahin 0000-0002-6602-2283

Samet Şahin 0000-0003-0748-3458

Erken Görünüm Tarihi 26 Nisan 2022
Yayımlanma Tarihi 29 Nisan 2022
Gönderilme Tarihi 3 Şubat 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 11 Sayı: 1

Kaynak Göster

APA Şahin, M. D., & Şahin, S. (2022). Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi. Abant Tıp Dergisi, 11(1), 11-21. https://doi.org/10.47493/abantmedj.1067988
AMA Şahin MD, Şahin S. Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi. Abant Med J. Nisan 2022;11(1):11-21. doi:10.47493/abantmedj.1067988
Chicago Şahin, Meltem Derya, ve Samet Şahin. “Cerrahi Sonrası Deliryum Gelişen Ve Ruh Sağlığı Ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi”. Abant Tıp Dergisi 11, sy. 1 (Nisan 2022): 11-21. https://doi.org/10.47493/abantmedj.1067988.
EndNote Şahin MD, Şahin S (01 Nisan 2022) Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi. Abant Tıp Dergisi 11 1 11–21.
IEEE M. D. Şahin ve S. Şahin, “Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi”, Abant Med J, c. 11, sy. 1, ss. 11–21, 2022, doi: 10.47493/abantmedj.1067988.
ISNAD Şahin, Meltem Derya - Şahin, Samet. “Cerrahi Sonrası Deliryum Gelişen Ve Ruh Sağlığı Ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi”. Abant Tıp Dergisi 11/1 (Nisan 2022), 11-21. https://doi.org/10.47493/abantmedj.1067988.
JAMA Şahin MD, Şahin S. Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi. Abant Med J. 2022;11:11–21.
MLA Şahin, Meltem Derya ve Samet Şahin. “Cerrahi Sonrası Deliryum Gelişen Ve Ruh Sağlığı Ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi”. Abant Tıp Dergisi, c. 11, sy. 1, 2022, ss. 11-21, doi:10.47493/abantmedj.1067988.
Vancouver Şahin MD, Şahin S. Cerrahi Sonrası Deliryum Gelişen ve Ruh Sağlığı ve Hastalıkları Kliniğine Konsülte Edilen Hastalarda Deliryum Tablosunun Yönetimi: Tek Merkez Deneyimi. Abant Med J. 2022;11(1):11-2.