Current conditions and risk factors for postoperative delirium in pediatric patients

doi:10.3877/cma.j.issn.1674-6880.2021.05.007

Abstract

Abstract:

Objective

To determine the occurrence of postoperative delirium in pediatric patients and explore associated risk factors.

Methods

A prospective cohort study was designed to collect clinical data of 1 134 children with routine elective surgery admitted to the Children's Hospital, Zhejiang University School of Medicine from February to June 2020. A multivariate Logistic regression model was used to analyze the risk factors for postoperative delirium in children, and the Hosmer-Lemeshow test was used to analyze the model calibration.

Results

Based on the occurrence of postoperative delirium, 1 134 children were divided into a delirium group (n = 126) and a non-delirium group (n = 1 008). The incidence of delirium was 11.11% (126/1 134), with the onset concentrated at 40.0 (35.0, 50.0) min after surgery and the duration of 10.0 (5.0, 15.0) min. The hospitalization time in the delirium group significantly increased compared with the non-delirium group [11.0 (7.0, 16.0) d vs. 4.0 (3.0, 7.0) d, Z = 13.791, P < 0.001]. The age (χ² = 75.129, P < 0.001), developmental delay (χ² = 14.995, P < 0.001), previous disease (χ² = 7.434, P = 0.006), type of surgery (χ² = 18.903, P < 0.001), fasting duration (Z = 3.048, P = 0.002), anesthesia duration (Z = 2.056, P = 0.040), pain degree (χ² = 347.649, P < 0.001) and dexmedetomidine (χ² = 4.904, P = 0.027) were statistically significantly different between the delirium group and non-delirium group. The multivariate Logistic regression analysis revealed that the age, developmental delay, type of surgery, pain degree and dexmedetomidine were risk factor of postoperative delirium in children (all P < 0.05). The Hosmer-Lemeshow test showed that the model had a good fitting effect (χ² = 12.833, P = 0.118).

Conclusion

Children are at risk for delirium after surgery, and those with age ≤ 5 years, developmental delay, otorhinolaryngology head and neck surgery, moderate to severe pain and dexmedetomidine are prone to postoperative delirium.

Key words: Pediatric, Postoperative delirium, Risk factors, Predictors

Nan Lin, Kexian Liu, Jingyi Feng, Ruan Chen, Yan Ying, Danni Lyu, Yue Zhou, Hongzhen Xu. Current conditions and risk factors for postoperative delirium in pediatric patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(05): 386-392.

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References 26

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组别	例数	年龄			性别		发育迟缓	存在既往疾病
组别	例数	0~2岁	3~5岁	6 ~ 16岁	男	女	发育迟缓	存在既往疾病
谵妄组	126	76（60.32）	42（33.33）	8（6.35）	83（65.87）	43（34.13）	13（10.32）	1（0.79）
非谵妄组	1 008	292（28.97）	274（27.18）	442（43.85）	593（58.83）	415（41.17）	32（3.17）	79（7.84）
χ²/Z值		75.129			2.308		14.995	7.434
P值		< 0.001			0.129		< 0.001	0.006
组别	例数	ASA分级		手术类型				夜间睡眠时长[h，M（P₂₅，P₇₅）]
组别	例数	Ⅰ级	Ⅱ级	耳鼻喉头颈外科手术	胸腹部手术	骨科手术	其他手术	夜间睡眠时长[h，M（P₂₅，P₇₅）]
谵妄组	126	98（77.78）	28（22.22）	59（46.83）	21（16.67）	25（19.84）	21（16.67）	8.58（8.00，9.50）
非谵妄组	1 008	828（82.14）	180（17.86）	304（30.16）	284（28.17）	284（28.17）	136（13.49）	8.75（8.00，9.50）
χ²/Z值		1.425		18.903				0.403
P值		0.233		< 0.001				0.687
组别	例数	禁食时长[h，M（P₂₅，P₇₅）]	麻醉时长[min，M（P₂₅，P₇₅）]	手术时长[min，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	疼痛程度
组别	例数	禁食时长[h，M（P₂₅，P₇₅）]	麻醉时长[min，M（P₂₅，P₇₅）]	手术时长[min，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	无痛或轻度疼痛	中度疼痛	重度疼痛
谵妄组	126	11.31（8.96，13.12）	52.00（40.00，81.00）	28.00（18.75，56.00）	1.00（1.00，5.00）	43（34.13）	45（35.71）	38（30.16）
非谵妄组	1 008	12.21（9.00，15.00）	58.00（45.00，78.00）	30.00（20.00，50.00）	2.00（1.00，5.00）	937（92.96）	53（5.26）	18（1.79）
χ²/Z值		3.048	2.056	1.609	1.430	347.649
P值		0.002	0.040	0.108	0.153	< 0.001
组别	例数	用药情况
组别	例数	丙泊酚	苯二氮类药物	皮质类固醇类药物	抗胆碱能药物	右美托咪定	阿片类受体激动剂	神经肌肉阻滞剂
谵妄组	126	123（97.62）	108（85.71）	76（60.32）	74（58.73）	85（67.46）	75（59.52）	67（53.17）
非谵妄组	1 008	976（96.83）	867（86.01）	603（59.82）	500（49.60）	576（57.14）	583（57.84）	513（50.89）
χ²/Z值		0.045	0.008	0.011	3.732	4.904	0.131	0.233
P值		0.832	0.928	0.915	0.053	0.027	0.718	0.629

组别	例数	年龄			性别		发育迟缓	存在既往疾病
组别	例数	0~2岁	3~5岁	6 ~ 16岁	男	女	发育迟缓	存在既往疾病
谵妄组	126	76（60.32）	42（33.33）	8（6.35）	83（65.87）	43（34.13）	13（10.32）	1（0.79）
非谵妄组	1 008	292（28.97）	274（27.18）	442（43.85）	593（58.83）	415（41.17）	32（3.17）	79（7.84）
χ²/Z值		75.129			2.308		14.995	7.434
P值		< 0.001			0.129		< 0.001	0.006
组别	例数	ASA分级		手术类型				夜间睡眠时长[h，M（P₂₅，P₇₅）]
组别	例数	Ⅰ级	Ⅱ级	耳鼻喉头颈外科手术	胸腹部手术	骨科手术	其他手术	夜间睡眠时长[h，M（P₂₅，P₇₅）]
谵妄组	126	98（77.78）	28（22.22）	59（46.83）	21（16.67）	25（19.84）	21（16.67）	8.58（8.00，9.50）
非谵妄组	1 008	828（82.14）	180（17.86）	304（30.16）	284（28.17）	284（28.17）	136（13.49）	8.75（8.00，9.50）
χ²/Z值		1.425		18.903				0.403
P值		0.233		< 0.001				0.687
组别	例数	禁食时长[h，M（P₂₅，P₇₅）]	麻醉时长[min，M（P₂₅，P₇₅）]	手术时长[min，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	疼痛程度
组别	例数	禁食时长[h，M（P₂₅，P₇₅）]	麻醉时长[min，M（P₂₅，P₇₅）]	手术时长[min，M（P₂₅，P₇₅）]	术中出血量[mL，M（P₂₅，P₇₅）]	无痛或轻度疼痛	中度疼痛	重度疼痛
谵妄组	126	11.31（8.96，13.12）	52.00（40.00，81.00）	28.00（18.75，56.00）	1.00（1.00，5.00）	43（34.13）	45（35.71）	38（30.16）
非谵妄组	1 008	12.21（9.00，15.00）	58.00（45.00，78.00）	30.00（20.00，50.00）	2.00（1.00，5.00）	937（92.96）	53（5.26）	18（1.79）
χ²/Z值		3.048	2.056	1.609	1.430	347.649
P值		0.002	0.040	0.108	0.153	< 0.001
组别	例数	用药情况
组别	例数	丙泊酚	苯二氮类药物	皮质类固醇类药物	抗胆碱能药物	右美托咪定	阿片类受体激动剂	神经肌肉阻滞剂
谵妄组	126	123（97.62）	108（85.71）	76（60.32）	74（58.73）	85（67.46）	75（59.52）	67（53.17）
非谵妄组	1 008	976（96.83）	867（86.01）	603（59.82）	500（49.60）	576（57.14）	583（57.84）	513（50.89）
χ²/Z值		0.045	0.008	0.011	3.732	4.904	0.131	0.233
P值		0.832	0.928	0.915	0.053	0.027	0.718	0.629

变量		回归系数	标准误	Wald值	P值	OR值	95%CI
常量		-4.688	0.466	101.338	< 0.001	0.009	-
年龄		-	-	30.021	< 0.001	-	-
	3~5岁	1.773	0.427	17.225	< 0.001	5.888	2.549 ~ 13.602
	0~2岁	2.297	0.421	29.828	< 0.001	9.944	4.361 ~ 22.676
发育迟缓		1.404	0.481	8.504	0.004	4.070	1.584 ~ 10.454
手术类型		-	-	13.790	0.003	-	-
	骨科手术	-1.217	0.343	12.608	< 0.001	0.296	0.151 ~ 0.580
	胸腹部手术	-0.677	0.324	4.359	0.037	0.508	0.268 ~ 0.959
	其他手术	-0.482	0.362	1.779	0.182	0.617	0.304 ~ 1.254
疼痛程度		-	-	145.902	< 0.001	-	-
	中度疼痛	2.835	0.292	94.020	< 0.001	17.032	9.603 ~ 30.210
	重度疼痛	3.755	0.376	99.713	< 0.001	42.717	20.443 ~ 89.259
右美托咪定		0.666	0.264	6.353	0.012	1.947	1.160 ~ 3.270

变量		回归系数	标准误	Wald值	P值	OR值	95%CI
常量		-4.688	0.466	101.338	< 0.001	0.009	-
年龄		-	-	30.021	< 0.001	-	-
	3~5岁	1.773	0.427	17.225	< 0.001	5.888	2.549 ~ 13.602
	0~2岁	2.297	0.421	29.828	< 0.001	9.944	4.361 ~ 22.676
发育迟缓		1.404	0.481	8.504	0.004	4.070	1.584 ~ 10.454
手术类型		-	-	13.790	0.003	-	-
	骨科手术	-1.217	0.343	12.608	< 0.001	0.296	0.151 ~ 0.580
	胸腹部手术	-0.677	0.324	4.359	0.037	0.508	0.268 ~ 0.959
	其他手术	-0.482	0.362	1.779	0.182	0.617	0.304 ~ 1.254
疼痛程度		-	-	145.902	< 0.001	-	-
	中度疼痛	2.835	0.292	94.020	< 0.001	17.032	9.603 ~ 30.210
	重度疼痛	3.755	0.376	99.713	< 0.001	42.717	20.443 ~ 89.259
右美托咪定		0.666	0.264	6.353	0.012	1.947	1.160 ~ 3.270

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