摘要
目的探讨重症监护病房(ICU)患者谵妄的发生率、危险因素、谵妄持续时间及转归。方法采用前瞻性观察性研究方法,选择2021年9月至11月入住贵州医科大学附属医院重症医学科的重症患者作为调查对象。对符合纳入和排除标准的患者每日采用Richmond躁动-镇静评分(RASS)与ICU意识模糊评估法(CAM-ICU)进行2次谵妄评估。记录患者年龄、性别、体质量指数(BMI)、基础疾病、入ICU时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、氧合指数(PaO_(2)/FiO_(2))、疾病诊断、谵妄类型、谵妄持续时间及转归等。根据患者研究期间是否发生谵妄分为谵妄组和非谵妄组,比较两组患者的临床特征,采用单因素分析和多因素Logistic回归分析筛选发生谵妄的危险因素。结果共纳入ICU患者347例,有57.6%(200/347)患者发生谵妄,其中最常见的为抑郁型谵妄(占73.0%)。单因素分析显示,两组患者在年龄、入ICU时APACHEⅡ评分和SOFA评分、吸烟史、高血压、脑梗死史、免疫抑制、神经系统疾病、脓毒症、休克、血糖(Glu)、入ICU时PaO_(2)/FiO_(2)、ICU住院时间、机械通气时间方面比较差异均有统计学意义。多因素Logistic回归分析显示,年龄〔优势比(OR)=1.045,95%可信区间(95%CI)为1.027~1.063,P<0.001〕、入ICU时APACHEⅡ评分(OR=1.049,95%CI为1.008~1.091,P=0.018)、神经系统疾病(OR=5.275,95%CI为1.825~15.248,P=0.002)、脓毒症(OR=1.941,95%CI为1.117~3.374,P=0.019)及机械通气时间(OR=1.005,95%CI为1.001~1.009,P=0.012)均是ICU患者发生谵妄的独立危险因素。ICU患者谵妄的中位持续时间为2(1,3)d,52%的谵妄患者转出ICU时仍存在谵妄。结论ICU患者谵妄的发生率超过50%,其中抑郁型谵妄最常见。年龄、入ICU时APACHEⅡ评分、神经系统疾病、脓毒症及机械通气时间均是ICU患者发生谵妄的独立危险因素。超过一半的患者转出ICU时仍存在谵妄。
Objective To investigate the prevalence,risk factors,duration and outcome of delirium in intensive care unit(ICU)patients.Methods A prospective observational study was conducted for critically ill patients admitted to the department of critical care medicine,the Affiliated Hospital of Guizhou Medical University from September to November 2021.Delirium assessments were performed twice daily using the Richmond agitation-sedation scale(RASS)and confusion assessment method of ICU(CAM-ICU)for patients who met the inclusions and exclusion criteria.Patient's age,gender,body mass index(BMI),underlying disease,acute physiologic assessment and chronic health evaluation(APACHE)at ICU admission,sequential organ failure assessment(SOFA)at ICU admission,oxygenation index(PaO_(2)/FiO_(2)),diagnosis,type of delirium,duration of delirium,outcome,etc.were recorded.Patients were divided into delirium and non-delirium groups according to whether delirium occurred during the study period.The clinical characteristics of the patients in the two groups were compared,and risk factors for the development of delirium were screened using univariate analysis and multivariate Logistic regression analysis.Results A total of 347 ICU patients were included,and delirium occurred in 57.6%(200/347)patients.The most common type was hypoactive delirium(73.0%of the total).Univariate analysis showed statistically significant differences in age,APACHE score and SOFA score at ICU admission,history of smoking,hypertension,history of cerebral infarction,immunosuppression,neurological disease,sepsis,shock,glucose(Glu),PaO_(2)/FiO_(2) at ICU admission,length of ICU stay,and duration of mechanical ventilation between the two groups.Multivariate Logistic regression analysis showed that age[odds ratio(OR)=1.045,95%confidence interval(95%CI)was 1.027-1.063,P<0.001],APACHE score at ICU admission(OR=1.049,95%CI was 1.008-1.091,P=0.018),neurological disease(OR=5.275,95%CI was 1.825-15.248,P=0.002),sepsis(OR=1.941,95%CI was 1.117-3.374,P=0.019),and duration of mecha
作者
何德华
张乾富
周晓倩
钟剑敏
林显雯
沈锋
刘颖
唐艳
王迪芬
刘旭
He Dehua;Zhang Qianfu;Zhou Xiaoqian;Zhong Jianmin;Lin Xianwen;Shen Feng;Liu Ying;Tang Yan;Wang Difen;Liu Xu(Department of Critical Care Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第6期638-642,共5页
Chinese Critical Care Medicine
基金
国家重点研发计划项目(2018YFC2001904)
国家自然科学基金(81960357,81701958)
贵州省科技计划项目(2020-1Y330,ZK-2022-370)
吴阶平医学基金会临床科研专项资助基金项目(320.6750.18001)。
关键词
重症监护病房
谵妄
发生率
危险因素
转归
Intensive care unit
Delirium
Prevalence
Risk factor
Outcome
