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Identification risk factors for postoperative delirium in cardiac coronary and valve patients

dc.contributor.advisorPutnik, Svetozar
dc.contributor.otherPavlović, Siniša
dc.contributor.otherSavić, Dragutin
dc.contributor.otherSovtić, Saša
dc.creatorNikolić, Bojan
dc.date.accessioned2018-11-30T16:40:21Z
dc.date.available2018-11-30T16:40:21Z
dc.date.available2020-07-03T08:50:24Z
dc.date.issued2018-09-28
dc.identifier.urihttp://eteze.bg.ac.rs/application/showtheses?thesesId=6225
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/10213
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:18831/bdef:Content/download
dc.identifier.urihttp://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=50664463
dc.description.abstractPostoperativni delirijum je je jedna os najčešćih komplikacija nakon svih vrsta operativnih zahvata, naročito u kardiohirurgiji. Povezan je sa lošijom prognozom oporavka pacijenta nakon operacije, produženom hospitalizacijom kao i povećanim rizikom od dugotrajne kognitivne disfunkcije i mortalitetom u poređenju sa pacijentima bez ove komplikacije. Cilj rada je da se identifikuju faktori rizika za pojavu postoperavnog delirijuma kod dve grupe pacijenata: prva grupakoronarni pacijenti i druga grupa- bolesnici sa valvularnom bolesti kao i njihovo poređenje učestalosti između ove dve grupe. Faktori rizika su odabrani na osnovu literature i do sada objavljenih studija i podeljeni su na: preoperativne, intraoperativne i postoperativne. Preoperativni faktori rizika su: pol, godine, hipertenzija, dijabetes, preoperativna fibrilacija, neurološka bolest, hronična opstruktivna bolest pluća, cerebrovaskularna bolest, periferna vaskularna bolest, korišćenje alkohola i opijata, hronična bubrežna insuficijencija, hiperlipidemija. Intraoperativni faktori rizika su: dužina operacije, trajanje kardiopulmonarnog baypassa, trajanje srčanog zastoja, promenjena doza Fenatanyla i postoperativni su: postoperativna fibrilacija, inotropna potpora, trajanje intubacije, postoperativna transfuzija. Materijal i metode: Na Klinici za Kardiohirurgiju KCS urađena je prospektivna kohortna studija od 01.01.2015. do kraja godine, u nju je bilo uključeno 792 pacijenta, 557 u grupi bolesnika sa bolešću koronarnih arterija i 235 bolesnika sa oboljenjem srčanih valvula. Delirijum je dijagnostikovan testom CAM( Confusion Assestment Method ), koji ima najveću validnost i najčešće se koristi za procenu mentalnog stanja pacijenta. Dobijeni rezultati su obrađeni metodama deskriptivne i analitičke statistike. Za kontinuirane varijable koje slede normalnu raspodelu podaci su prikazani kao srednje vrednosti i standardna varijacija a za varijable koje ne slede normalnu raspodelu kao medijan i treći kvartil. Za proveru tipa raspodele kontinuarih podataka korišćen je Kolmoogoro-Smirnov test. Rezultati: Postoperativni delirijum je dijagnostikovan kod 53 bolesnika sa koronarnom bolešću i kod 28 bolesnika sa oboljenjem srčanih valvula. Kod koronarnih pacijenata statistički značajni preoperativni faktori rizika bili su dijabetes i hronična opstruktivna bolest pluća, a od postoperativnih prolongirama intubacija. Kod bolesnika sa valvularnom bolešću samo je prolongirana intubacija bila statistički značajan faktor za pojavu postoperativnog delirijuma . Zaključak: U ovoj studiji dva potencijalna faktora rizika su povezani sa postoperativnim delirijumom, što nam može pomoći da identifikujemo pacijente sa povećanim rizikom od ove postoperativne komplikacije. Smanjenjem trajanje itubacije ovih bolesnika može dovesti do smanjenja broja delirijantnih pacijenata i negativnih posledica delirijuma po njih.sr
dc.description.abstractDelirium is a temporary mental disoreder that frequently occurs among elderly hospitalized patients. Patients who undergo cardiac operations have an increased risk of postoperative delirium, which is associated with higher mortality and morbidity rates a prolonged hospital stay and reduced cognitive and functional recovery. Generally thr incidence of postoperative delirium is approximately 10% to 30% and is a high as 70% in elderly patients. The aim of this study was to develop a checklist( preoperative, intraoperative and postoperative ) to identify patients at increased risk of postoperative delirium after corononary on pump surgery( first group of patients ) avd valve surgery( second group of patients ). Preoperative factors were: sex, age, diabetes mellitus, arterial hypertension, histori of cerebrovascular disease, peripheral vascular disease, markedly abnormal renal function, preoperative use of alcohol and opiates chronic lung disease, hyperlipidemia. Intraoperative factors were: operation time, cardiopulmonary baypass time, circulatory arrest time and the fentanyl dose use for anesthesia. Postoperative veriables were intubation time, postoperative fibrillation, peiroperative inotropic support, a high perioperative transfusion requirement. Methods: The study was contucted at Clinic for Cardiac surgery, Clinical Center of Serbia. In this prospective cohort study it was included 792 patints, 557 coronary patients and 235 valve patients who underwent coronary and valve surgery from 01.01.2015. until the end of the year. Delirium was diagnosed with CAM( Confusion Assessment Method ) mental test. All data are presented as the mean and SD, or as percentage. Frequencies were tabulated for each risk factor of the patients.Differences in prevalence were identified with Kolmogoro-Smirnov test after continuos variables were broken up into categories. Results: Postoperative delirium was diagnosed in 53 coronary patients and 28 valve patients. Coronary patients had three predictive factors that were associated with postoperative delirium, two wer preoperative- diabetes mellitus and chronic lung disease, and one was postoperative- prolonged intubation. Valve patients had only one predictive factor- prolonged intubation. Conclusion: Two of free predictive factors significantly associated with postoperative delirium were preoperative. They are easy to measure and they can be used to identify patients at higher risk. Fast extubation of these patients and preventive interventions can be taken to prevent negative consequences of this postoperative complication.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Београду, Медицински факултетsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Београдуsr
dc.subjectpostoperativni delirijumsr
dc.subjectpostoperative deliriumen
dc.subjectkoronarni bolesnicisr
dc.subjectbolesnici sa oboljenjem srćanih valvulasr
dc.subjectfaktori rizikasr
dc.subjectCAM( Confusion Asseesstment Method)sr
dc.subjectcardiac patientsen
dc.subjectvalve patientsen
dc.subjectCAM( Confusion Assessment Method)en
dc.titleIdentifikacija faktora rizika za nastanak postoperativnog delirijuma kod pacijenata sa bolešću koronarnih arterija i srčanih valvulasr
dc.title.alternativeIdentification risk factors for postoperative delirium in cardiac coronary and valve patientsen
dc.typedoctoralThesis
dc.rights.licenseBY-NC-SA
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/9863/IzvestajKomisije18409.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/9862/Disertacija.pdf


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