摘要
目的 探讨重症加强治疗后综合征（PICS）患者发生认知障碍（PICS-CI）的危险因素.方法 回顾性分析2015年10月至2016年11月辽宁省锦州医科大学附属第一医院由重症加强治疗病房（ICU）转出并入住普通病房≥7 d、年龄≥18周岁患者的临床资料.记录患者的性别、年龄、婚姻状态、学历、职业、支付方式、经济收入、吸烟、饮酒、既往史、机械通气、ICU住院时间、有无镇静、谵妄、入ICU诊断.根据简易智能精神状态检查量表（MMSE）将患者分为认知障碍组和非认知障碍组.采用单因素分析PICS-CI的危险因素,将有统计学意义的危险因素纳入二元logistic回归分析,从而找出PICU-CI发生的独立危险因素.结果290例PICS患者中发生认知障碍者104例,发生率为35.86%.单因素分析显示,是否发生认知障碍两组患者间性别、年龄、学历、经济收入、吸烟、饮酒、既往史、机械通气、ICU住院时间、镇静、谵妄、入ICU诊断差异均有统计学意义.二分类logistic回归分析显示,年龄〉60岁〔优势比（OR）=7.523,95%CI可信区间（95%CI）=2.572-37.851,P=0.001〕、机械通气（OR=8.773,95%CI=2.588-36.344,P〈0.001）、 镇静（OR=9.376,95%CI=2.661-42.011,P=0.002）、谵妄（OR=13.201,95%CI=2.502-41.433,P〈0.001）是PICS患者发生认知障碍的独立危险因素.结论 护理人员应加强对ICU转出患者的关注,从不同角度对患者实施有针对性的预防措施,从而减少PICS患者认知障碍的发生.
Objective To investigate the risk factors of cognitive impairment in post-intensive care syndrome patient （PICS-CI）.Methods A retrospective study was conducted. The patient who transferred from post-intensive care unit （ICU） to the general ward for more than 7 days, and with the age ≥ 18 years old in the First Affiliated Hospital of Jinzhou Medical University from October 2015 to November 2016 were enrolled. The gender, age, marital status, education, occupation, salary, economic income, smoking, alcohol drinking, previous of history, mechanical ventilation, the length of ICU stay, sedative and delirium, and initial diagnosis were recorded. According to mini-mental state examination （MMSE）, the patients were divided into cognitive impairment （CI） group and non-CI group. Univariate analysis was performed to identify the risk factors of PICS-CI, and variables with statistical difference were selected to do multivariate binary logistic regression analysis for the confirmable independence risk factors.Results 104 of the 290 patients developed CI, and the incidence was 35.86%. Univariate analysis showed that the gender, age, education, financial situation, smoking, alcohol drinking, previous of history, mechanical ventilation, the length of ICU stay, sedative and delirium, and initial diagnosis were recorded of ICU were main predictors of PICS-CI patients. It was shown by multivariate binary logistic regression analysis that the age 〉 60 years old [odds ratio （OR） = 7.523, 95% confidence interval （95%CI） = 2.572-37.851,P = 0.001], mechanical ventilation （OR = 8.773, 95%CI = 2.588-36.344,P 〈 0.001）, sedation （OR = 9.376, 95%CI = 2.661-42.011,P = 0.002）, and delirium （OR = 13.201, 95%CI = 2.502-41.433, P 〈 0.001） were PICS-CI independence risk factors.Conclusions Nurse staffs should strength care and attention on ICU transferred out patients. In order to minimize PICS impairment, special precaution should be implemented according to different aspects.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第8期716-720,共5页
Chinese Critical Care Medicine
基金
辽宁省教育厅科研一般项目（L2014324）
辽宁省教育“十二五”科学规划项目（JG15DB236）
