노인환자에서 대뇌질환에 의해 나타나는 섬망

한명일(Myeong Il Han) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

There are well known predisposing and precipitating factors for delirium in elderly patients. Although cerebral disease is a major precipitating factor for delirium, the concept of cerebral disease is not clear. Stroke is a typical condition reflecting intracranial change. There are not many studies about delirium post stroke. This paper reviewed delirium post stroke, instead of cerebral disease induced delirium as a whole. The etiology of delirium post stroke is not well established. The neuroanatomical site and the extent of stroke are important risk factors for the development of delirium. In spite of many limitations CAM, DRS, and MMSE are useful evaluating tools for delirium. In some cases of post stroke delirium, it was developed directly by stroke without any additional cause. In other cases there were also medical complications. And in the rest of the cases, there were multiple potential causes for delirium. Although there are not specific preventive interventions for delirium post-stroke, identifying and correcting the underlying stroke, as well as preventing secondary medical complications are important. Multicomponent non-pharmacological interventions are helpful to prevent delirium, and pharmacological methods for treating behavioral symptoms are sometimes necessary. There should be more studies about cerebral disease induced delirium.

간호사의 섬망관련 지식, 간호 자신감과 섬망 간호 수행과의 관계

박향미 ( Park Hyang-mi ),장미영 ( Mi Young Chang ) 한국보건정보통계학회(구 한국보건통계학회) 2016 보건정보통계학회지 Vol.41 No.4

Objectives: This study was conducted to investigate the correlation among nurses` knowledge, their self-confidence about care for delirium and nursing performance for patients with delirium. Methods: The study subjects are the 203 nurses working at general hospitals. The data were collected using the instruments for knowledge of delirium (47 items), performance (23 items), and self-confidence (15 items). The used statistical analysis were t-test, ANOVA, Pearson`s coefficient and multiple regression analysis. Results: Nursing performance level for patients with delirium was 2.85±0.47, knowledge of delirium nursing 32.15±4.36, and self-confidence in delirium nursing 52.00±17.05. The difference in performance were associated with number of caring experience with delirious patients (during for 1 year) (F=3.22, p=0.024), perceived importance (Caring delirious patient is an important nursing intervention) (F=5.85, p=0.003), necessity of education for delirium (F=5.58, p=0.004), and necessity of manuals for delirium care (t=2.11, p=0.036). The nursing performance for patients with delirium had positive relationship with knowledge of delirium (r=0.30, p=0.000) and self-confidence (r=0.35, p=0.000). Factors related to the nursing performance for patients with delirium were `self-confidence in nursing performance for patients with delirium` (β=0.24, p=0.001), `knowledge of delirium` (β=0.16, p=0.002), and `necessity of manuals for delirium care` (β=0.16, p=0.014). These variables explained 18.5% of the variance in nursing performance for patients with delirium. Conclusions: It is necessary to develop systematic educational program and manual for improving the knowledge, self-confidence and performance for patients with delirium among nurses working at general hospitals.

Delirium characteristics and outcomes in medical and surgical lnpatients: A subgroup analysis

Kim, Sungmin,Kim, Jae-Jin,Oh, Jooyoung,Park, Jaesub,Park, Jin Young Elsevier 2018 Journal of critical care Vol.43 No.-

<P><B>Abstract</B></P> <P><B>Purpose</B></P> <P>Persistent delirium can negatively affect patients, increase healthcare costs, and extend the length of hospital stays. This investigation was undertaken to explore associations between patient characteristics and delirium outcomes.</P> <P><B>Materials and methods</B></P> <P>Intensive care unit (ICU) and medical and surgical ward inpatients for whom psychiatric consultation was requested for delirium were included in this study. Delirium screening and ongoing assessments were conducted using the Confusion Assessment Method for ICU patients.</P> <P><B>Results</B></P> <P>Postoperative delirium developing as a secondary complication following surgery was found to be of significantly longer duration and associated with greater length of hospitalization compared with postoperative delirium attributable to surgery and delirium in medical patients. Medical patients with delirium had lower delirium recovery rates at discharge compared with surgical patients.</P> <P><B>Conclusions</B></P> <P>The findings that patient type and timing of postoperative delirium are associated with differential delirium outcomes suggest that targeted screening and intervention approaches may be needed. Medical patients were more likely to be discharged before recovery from delirium compared with surgical patients. Differences in underlying chronic medical conditions may account for the observed differences in discharge condition between medical and surgical patients with delirium.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Delirium is a commonly observed condition following surgical intervention. </LI> <LI> Previous research on postoperative delirium focused on vulnerable populations. </LI> <LI> We explored delirium progression between medical and surgical patient populations. </LI> <LI> Delirium duration, delirium recovery, and length of hospital stay were measured. </LI> </UL> </P>

소아중환자실 간호사를 위한 다면적 소아 섬망 교육프로그램이 섬망 지식, 섬망 간호에 대한 자신감, 섬망 사정 정확도에 미치는 효과: 단일군 전후설계

남송이,최수정,오사랑,최지은,박기영 한국중환자간호학회 2023 중환자간호학회지 Vol.16 No.1

Purpose : This study aimed to identify the effects of a multifaceted pediatric delirium education program for pediatric intensive care unit (PICU) nurses on their delirium knowledge, confidence in delirium nursing, and delirium evaluation accuracy. Methods : This study used a one-group pretest-posttest design. The participants were 50 nurses in two units of the PICU at S General Hospital in Seoul. All participants took a 1-hour lecture with case-based practice for the first two weeks, and received feedback as they applied the program to clinical practice over the next two weeks. Test measures were completed before and after the four week intervention period for all participants. The delirium evaluation accuracy was measured using the Korean version of the Cornell Assessment of Pediatric Delirium. Data were analyzed using the chi-square and paired t-tests.Results : After the Pediatric Delirium Education Program, nurses’ delirium knowledge (x2 =11.65, p =.001), confidence in delirium nursing (t=9.71, p<.001), and delirium evaluation accuracy (t=6.07, p<.001) improved significantly. Conclusions : Pediatric delirium education programs for PICU nurses were effective. For active application of the program in clinical practice in the future, various cases of childhood delirium and specific strategies for each subject must be developed. To achieve this, long-term intervention and research for multiple organizations are required.

외과계 병동 노인 수술 환자의 섬망 발생률과 위험요인

이은주,장미,김명화,윤혜전,김은미,정영인,김보경,임은수,홍경순 병원간호사회 2022 임상간호연구 Vol.28 No.2

Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (x2=10.79, p=.005), systemic-specific disease (x2=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (x2=15.90, p<.001), walking ability before surgery (x2=7.65, p=.006), history of delirium (x2=35.92, p<.001), and emergency surgery (x2=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors. 목적: 본 연구는 노인 수술 환자의 섬망 발생률과 섬망 발생 관련 요인을 파악하기 위해 시행된 후향적 서술적 조사연구이다. 방법: 연구 대상자는 수술을 받은 만 65세 이상의 환자 394명이었다. 수술 후 섬망 진단은 간호사가 수술 당일부터 수술 후 4일까지 도구로 측정한 점수를 간호일지를 통하여 조사하였고, 수집된 자료는 Binary logistic regression으로 분석하였다. 결과: 연구 대상자의 섬망 발생률은 4.3%이었고, 섬망 발생시기는 수술 1일째에 가장 많이 발생해 평균 2.16일간 지속된 것으로 나타났다. 섬망 발생군 총 17명 중 76.5%가 위장관계 수술 환자였고, 섬망 양상은 지남력 저하가 100.0%로 가장 많았다. 대상자의 특성에 따른 섬망 발생은 나이(χ²=10.79, p=.005), 계통적 질환명(χ²=9.63, p=.047), 수술 전 섬망 유발 약물(벤조다이아제핀) 사용 여부(χ²=15.90, p<.001), 수술 전 활동상태(χ²=7.65, p=.006), 이전 섬망 경험(χ²=35.92, p<.001)과 응급수술 유무(χ²=16.40, p<.001)에 따라 통계적으로 유의한 차이를 보였다. 섬망 발생여부에 미치는 위험요인은 위장관계 수술인 경우 다른 수술에 비해 섬망 발생 위험이 12.57배(95% CI= 2.45∼64.46, p=.002), 수술 전 벤조다이아제핀 등 섬망 유발 약물을 복용했던 환자의 경우 10.07배(95% CI= 2.21∼45.87, p=.003) 증가하는 것으로 나타났다. 결론: 간호사는 노인 수술 환자의 섬망을 조기발견 및 예방하기 위해 선별 도구를 사용해서 적극적으로 섬망을 사정할 필요가 있다.

섬망 심각도와 관련된 위험 요인

서영은,김태석,원왕연,이창욱,이철 대한신경정신의학회 2010 신경정신의학 Vol.49 No.6

ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms. ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms.

Delirium-Related Knowledge, Caregiving Performance, Stress Levels, and Mental Health of Family Caregivers of Terminal Cancer Patients with Delirium in a Hospice Care Unit

Jung, Mi Hyun,Park, Myung-Hee,Kim, Su-Jeong,Ra, Jeong Ran Korean Society for Hospice and Palliative Care 2021 한국호스피스.완화의료학회지 Vol.24 No.2

Purpose: The purpose of this study was to examine the knowledge, caregiving performance, stress levels, and mental health of family caregivers of terminal cancer patients with delirium, insofar as these characteristics are relevant for delirium. Methods: Between May 1, 2019, and June 1, 2020, 96 family caregivers of terminal cancer patients with delirium completed a structured survey, the results of which were analyzed. Results: The average correct answer rate for delirium-related knowledge was 53.2% across all subcategories, which included knowledge of causes (41.5%), symptoms (65.4%), and caregiving (51.7%). The average score for family caregivers' performance of caregiving for delirium was 2.60±0.5, with subcategories including caregiving for patients without delirium (2.16±0.95), caregiving for patients with delirium (2.84±1.01), and stress related to caregiving for delirium (39.88±16.55), as well as categories such as patient-related caregiving (44.32±28.98), duty-related caregiving (44.21±30.15), and interpersonal relationship-related caregiving (22.35±25.03). For mental health, the average score among family caregivers was 1.96±0.70, with the highest score being for the category of additional items (2.28±0.84). Family caregivers of patients with hyperactive delirium as the delirium subtype had higher scores for caregiving performance than caregivers of patients with mixed delirium. Conclusion: Scores for the delirium-related knowledge and caregiving performance of family caregivers were low, while their caregiving stress levels were high due to their lack of knowledge and experience. This indicates the importance of delirium-related education for family members of patients with delirium and the necessity of developing nursing intervention programs to help manage stress and promote mental health among family caregivers.

노인 입원환자에서 Delirium Drug Scale과 섬망 발생의 연관성 분석

김건희,박가영,전수정,이정화,이은숙,김광일,김은경 한국병원약사회 2020 병원약사회지 Vol.37 No.3

Background : Drugs are one of the major causes of delirium in elderly patients. As drug-associated delirium is usually reversible, evaluating the drug burden is clinically important in terms of delirium prevention. The Delirium Drug Scale (DDS) is a quantification tool developed to assess the impact of drugs on delirium in elderly patients. This study aimed to investigate the association between the scores and the occurrence of delirium in Korean elderly hospitalized patients. Methods : We retrospectively reviewed the electronic medical records of patients who were admitted to a tertiary university hospital from January to December 2017, and underwent Comprehensive Geriatric Assessment. Lists of medications taken by the patients at the time of admission were collected and the occurrence of delirium within two days after admission was identified. The DDS score of each patient was calculated based on the collected medication data. The relationship between DDS scores and delirium occurrence was analyzed using logistic regression. Results : A total of 452 patients were included in the study. The mean age of the patients was 82.0 ± 7.2 years. Delirium was detected in 54 patients (11.9%) and 258 patients (57.1%) were exposed to one or more drugs known to be associated with delirium. The unadjusted odds ratio (OR) for the DDS score was 2.02 (95% confidence interval [CI]:1.66; 2.46). In the multivariable analysis, a history of delirium, polypharmacy, infection, dementia, and age were significantly associated with delirium. When the confounding variables were adjusted, DDS scores were associated with the occurrence of delirium with an OR of 2.15 (95% CI: 1.69; 2.73). Conclusion : DDS scores were associated with delirium occurrence among hospitalized older patients in Korea. The DDS can be considered an objective index when providing medication review services as part of a delirium prevention practice.

중환자실 섬망 환자와 비섬망 환자 구분에 기여하는 임상 지표에 관한 연구

고찬영,김재진,조동래,오주영,박진영 한국정신신체의학회 2019 정신신체의학 Vol.27 No.2

Objectives:It is not clear which clinical variables are most closely associated with delirium in the Intensive Care Unit (ICU). By comparing clinical data of ICU delirium and non-delirium patients, we sought to identify variables that most effectively differentiate delirium from non-delirium. Methods:Medical records of 6,386 ICU patients were reviewed. Random Subset Feature Selection and Principal Component Analysis were utilized to select a set of clinical variables with the highest discriminatory capacity. Statistical analyses were employed to determine the separation capacity of two models-one using just the selected few clinical variables and the other using all clinical variables associated with delirium. Results:There was a significant difference between delirium and non-delirium individuals across 32 clinical variables. Richmond Agitation Sedation Scale (RASS), urinary catheterization, vascular catheterization, Hamilton Anxiety Rating Scale (HAM-A), Blood urea nitrogen, and Acute Physiology and Chronic Health Examination II most effectively differentiated delirium from non-delirium. Multivariable logistic regression analysis showed that, with the exception of vascular catheterization, these clinical variables were independent risk factors associated with delirium. Separation capacity of the logistic regression model using just 6 clinical variables was measured with Receiver Operating Characteristic curve, with Area Under the Curve (AUC) of 0.818. Same analyses were performed using all 32 clinical variables;the AUC was 0.881, denoting a very high separation capacity. Conclusions:The six aforementioned variables most effectively separate delirium from non-delirium. This highlights the importance of close monitoring of patients who received invasive medical procedures and were rated with very low RASS and HAM-A scores. 연구목적중환자실 환자들의 섬망 발생 유무와 관련이 되어 있는 것으로 알려진 많은 임상 지표들이 있지만, 이 중 실제 섬망군과 비섬망군을 분류하는 데 있어서 어떠한 지표가 보다 중요한 역할을 하는지에 대한 연구는 충분히이루어지지 않았다. 본 연구는 중환자실 내에서 섬망이 발생한 군과 발생하지 않은 군 사이의 재실 기간 내 특징을 비교하고, 두 군을 효과적으로 구분할 수 있는 임상 지표들을 확인하고자 하였다. 방 법2013년 3월 1일부터 2017년 5월 31일까지 강남세브란스병원 중환자실에 있던 6386명의 환자들 중, 섬망과연관성을 보일 것으로 예상되는 40개의 임상 지표에 대한 데이터가 재실 기간 중 적어도 한 번 이상 측정되거나, 확인이 가능한 환자 1559명을 대상으로 하였다. 무작위 부분집합 특징 선택 방법 및 주성분분석을 사용하여 섬망과 비섬망을 구분하는 데에 기여도가 높은 특징들의 순위를 구하고, 몇 개의 상위 지표가 동시에 사용되었을 때에 섬망과 비섬망을 가장 효율적으로 판별할 수 있는지를 확인하였다. 확인된 상위 지표만을 이용한것과 전체 임상 지표를 모두 사용하였을 때의 섬망과 비섬망을 구분할 수 있는 정확도에 대해서 비교 분석하였다. 결 과총 40개 변수 중 32개의 변수에서 섬망과 비섬망군 간 유의미한 차이를 보였다. 주성분 분석(Principal Component Analysis, PCA)상, 상위 6개 변수인 리치몬드 흥분 진정 척도(Richmond Agitation Sedation Scale, RASS), 도뇨관 사용 유무, 혈관 카테터 사용 유무, 해밀턴 불안 척도(Hamilton Anxiety Rating Scale, HAM-A), 혈액 요소 질소(Blood Urea Nitrogen, BUN), 급성 생리학 및 만성 건강 평가-II (Acute Physiology and Chronic Health Examination II, APACHE II)를 사용했을 때에 섬망과 비섬망군이 가장 잘 구분되었다. 이들 상위 6개 변수에 대해 단일 변수 로지스틱 회귀분석 시행 시 모두 섬망 여부 결정에 대한 유의성을 보였다. 다중 변수 회귀분석 시행 시, 혈관 카테터 사용 유무 를 제외하고 나머지 5개 변수에서 모두 섬망 여부결정에 대한 유의성을 보였다. 수신자판단특성곡선 분석 결과 신뢰구간 95%에서 곡선하면적 0.818로 높은 판별력을 보였다. 전체 임상 변수를 모두 사용한 수신자판단특성곡선 분석 결과에서는 곡선하면적 0.881로 매우높은 판별력을 보였다. 결 론본 연구 결과, 리치몬드 흥분 진정 척도, 도뇨관 사용 유무, 혈관 카테터 사용 유무, 해밀턴 불안 척도, 혈액요소 질소, 급성 생리학 및 만성 건강 평가-II가 섬망이 발생한 군과 섬망이 발생하지 않은 군을 구분하는데가장 유용하였다. 중환자실 환자 중 리치몬드 흥분 진정 척도 및 해밀턴 불안 척도 점수가 과도하게 낮거나, 도뇨관 및 혈관 카테터 등의 침습적인

고령의 환자에서 고관절 치환술 후 발생한 섬망

황성관 ( Sung Kwan Hwang ),이창호 ( Chang Ho Lee ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.2

Purpose: Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty, and risk factors for postoperative delirium in individuals older than 65. Materials and Methods: Among patients who received hip arthroplasty in our hospital (WCH) between March 2004 and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131 patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked for multiple factors related to delirium. Results: The mean hospital stay was 42.4±14.0 in the delirium group and 20.4±4.3 in the control group; the difference was significant. The mean preoperative cumulative ambulation score was 1.9±1.2 in the delirium group and 3.1±1.7 in the control group; the difference was significant. In 2 individuals of the control group and 4 of the delirium group, dislocation developed;and there was significant difference. There was a high prevalence of delirium among patients with hip fractures, and of histories of psychiatric diseases, alcohol abuse, liver cirrhosis and cerebral vascular disease. The delirium group had a significantly longer stay in the intensive care unit. On admission, the delirium group had significantly lower sodium and albumin compared to controls. Conclusion: Because postoperative delirium after hip arthroplasty makes the prognosis worse, preoperative evaluation and management of risk factors is necessary.