Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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The Changing Patterns and Predisposing Factors of Delirium at End of Life in Palliative Care Unit

완화 병동에서 임종기 섬망의 변화 양상과 선행 요인

  • Rim, Mi-Roo (Department of Psychiatry, Inha University Hospital) ;
  • Kang, Sang-Gu (Department of Psychiatry, Inha University Hospital) ;
  • Choi, Seo-Hyeon (Department of Psychiatry, Inha University Hospital) ;
  • Cho, Jinhyun (Department of Internal Medicine, Inha University Hospital) ;
  • Lee, Moon-Hee (Department of Internal Medicine, Inha University Hospital) ;
  • Kim, Hye-Young (Department of Internal Medicine, Inha University Hospital) ;
  • Bae, Jae-Nam (Department of Psychiatry, Inha University Hospital) ;
  • Lee, Jeong-Seop (Department of Psychiatry, Inha University Hospital) ;
  • Kim, Won-Hyoung (Department of Psychiatry, Inha University Hospital)
  • 임미루 (인하대학교 의과대학 정신건강의학교실) ;
  • 김상구 (인하대학교 의과대학 정신건강의학교실) ;
  • 최서현 (인하대학교 의과대학 정신건강의학교실) ;
  • 조진현 (인하대학교 의과대학 내과학교실) ;
  • 이문희 (인하대학교 의과대학 내과학교실) ;
  • 김혜영 (인하대학교 의과대학 내과학교실) ;
  • 배재남 (인하대학교 의과대학 정신건강의학교실) ;
  • 이정섭 (인하대학교 의과대학 정신건강의학교실) ;
  • 김원형 (인하대학교 의과대학 정신건강의학교실)
  • Received : 2018.07.31
  • Accepted : 2018.10.10
  • Published : 2018.12.31
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Abstract

Objectives : The purpose of this study is to investigate the change pattern and the leading factors of delirium in the palliative ward from 2 weeks before to the end of life. Methods : From October 2015 to August 2017, a retrospective chart review was conducted on the final 180 patients of 207 patients with terminal cancer patients at the Inha University Hospital. Clinical records were collected during palliative care hospitalization. Patients were diagnosed with three subtypes of delirium through the Richmond Agitation Sedation Scale and the Nursing Delirium Screening Scale, which were evaluated daily. Results : The prevalence of delirium 13 days before death was 46%, of which 18.3% were hyperactive subtypes, 13.8% were hypoactive subtypes, and mixed subtypes were 13.8%. And hyperactive delirium gradually decreased with the approach to the end of the day, and the mixed subtype gradually increased until 4 days before the end of life. Of the patients, the day before death, 86.9% were diagnosed with delirium. In multivariate analysis, hematologic malignancy was associated with a lower rate of delirium at the end of life than gastrointestinal cancer. Overweight was associated with hyperactive, mixed, and hypoactive delirium. Conclusions : Most palliative care patients experienced delirium at the end of life. Overweight was considered as a protective factor that reduced the all subtypes of delirium at the end of life. Further prospective studies are needed to reveal the prevalence of terminal delirium, and their risk factors.

연구목적 본 연구는 완화병동에 입원한 환자들에서 사망 직전에 발생하는 임종기 섬망의 발생을 사망 전 2주시점 전부터 관찰하여 변화양상과 선행 요인을 관찰한 연구이다. 방 법 2015년 10월부터 2017년 8월까지, 일 대학병원 완화병동에 입원한 말기 암환자 최종 180명을 대상으로 후향적 연구를 진행하였다. 대상자는 매일 3회 Richmond Agitation Sedation Scale과 Nursing Delirium Screening Scale로써 섬망의 세가지 아형으로 진단되었다. 결 과 임종 13일 전 섬망의 빈도는 46%였으며, 그 중 18.3%는 과활동성, 13.8%는 저활동성 그리고 혼합성 아형은 13.8%를 차지하였다. 과활동성 섬망은 임종일까지 점차 감소하는 양상이었으며, 저활동성 아형과 혼합성 아형의 섬망은 임종 4일 전까지 점차 증가하는 양상이었다. 임종 하루 전 86.9%의 환자들은 섬망으로 진단되었다. 다변량 분석에서 위장관 암보다 혈액학적 암이 낮은 임종기 섬망과 연관이 있었으며 과체중도 낮은 임종기 섬망과 연관이 있었다. 결 론 많은 완화의료 환자들은 섬망을 경험하였으며, 과체중은 임종기의 모든 아형의 섬망을 낮추는 보호인자로 고려되었다. 차후 임종기 섬망의 빈도와 위험 인자를 밝히는 전향적 연구가 필요할 것이다.

Keywords

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Fig. 1. The prevalence of three subtypes of delirium by date prior to death.

Table 1. The mean of RASS and NU-DESC by date prior to death

JSSCBG_2018_v26n2_94_t0001.png 이미지

Table 2. Descriptive characteristics of the patients with cancer according to delirium at the end of life

JSSCBG_2018_v26n2_94_t0002.png 이미지

Table 3. The univariate and multivariate analysis of predisposing factors for terminal delirium

JSSCBG_2018_v26n2_94_t0003.png 이미지

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