摘要
目的分析ICU成人患者术后发生谵妄的危险因素。方法选取2017年1月至2018年6月连云港市第一人民医院ICU成人手术后患者250例,术后转入ICU第2天采用ICU意识模糊评估法(CAM-ICU)评估患者谵妄发生情况,根据是否发生谵妄分为谵妄组(110例)和非谵妄组(140例);分析术后谵妄的可能危险因素,包括性别、年龄、文化程度、术前合并基础病、ASA分级、手术时间、术后急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)、身体约束、ICU机械通气时间、术后视觉模拟评分(VRS)、术后使用镇静、镇痛药;对差异有统计学意义的因素进一步行多因素logistic回归分析寻找独立危险因素,同时比较两组患者机械通气时间、ICU总住院时间、治疗总费用及病死率。结果共110例患者发生谵妄,谵妄发生率44.0%;logistic多因素回归分析显示:患者年龄≥65岁、手术时间≥3 h、术后VRS评分≥4分、ASA分级2级以上、APACHE II评分、身体约束、受教育程度、ICU机械通气时间、使用镇静镇痛药是术后发生谵妄的独立危险因素;谵妄组机械通气时间、ICU总住院时间较非谵妄组明显延长,治疗总费用、病死率明显增加(均P<0.05)。结论ICU成人患者术后发生谵妄的独立危险因素众多,而术后谵妄患者的病死率增加。
Objective To analyze the risk factors for postoperative delirium in adult patients in ICU.Methods Two hundred and fifty adult patients admitted to ICU of Lianyungang First People's Hospital were enrolled in the study.The ICU confusion assessment method for the intensive care unit(CAM-ICU)was used to assess the incidence of delirium within 3 days after the operation.The delirium occurred in 110 cases(delirium group)and did not occur in 140 cases(non-delirium group).The gender,age,education level,underlying diseases,American Society of Anesthesiologists(ASA)disease classification,operation time,postoperative acute physiology and chronic health evaluation II(APACHE II),physical restraint,ICU mechanical ventilation time,postoperative visual analogue scale(visual analogue scale,VRS),postoperative use of sedatives and analgesics were documented.The risk factors of postoperative dilirium were analyzed with multivariate logistic regression analysis.Results The incidence of postoperative delirium was 44.0%(110/250).Multivariate Logistic regression analysis showed that age>65 years old,operation time>3 h,postoperative VRS score≥4,ASA grade 2 or higher,APACHE II score,body restriction,education level,ICU mechanical ventilation time,and the use of sedative analgesics were independent risk factors for postoperative delirium.The delirium patients had significantly longer mechanical ventilation time and total ICU hospital stay than the non-delirium group,and the total treatment cost and mortality were also significantly increased(all P<0.05).Conclusion There are many independent risk factors for postoperative delirium in ICU adult patients,and the mortality rate of postoperative delirium patients would increase.
作者
沈叶菊
王银龙
牟志芳
刘克喜
康秀文
SHEN Yeju;WANG Yinlong;MOU Zhifang;LIU Kexi;KANG Xiuwen(Department of Intensive Care Unit,the First People’s Hospital of Lianyungang City,Lianyungang 222002,China)
出处
《浙江医学》
CAS
2020年第21期2317-2319,2326,共4页
Zhejiang Medical Journal
基金
连云港市科技项目(SH1601)。
关键词
术后
谵妄
危险因素
分析
Postoperative
Delirium
Risk factors
Analysis
