ICU亚谵妄综合征评估及影响因素的范围综述

doi:10.3761/j.issn.2096-7446.2025.04.021

摘要/Abstract

摘要：

目的对国内外关于ICU患者亚谵妄综合征的发生情况展开范围综述，系统性地整理并阐述该综合征的相关概念、评估手段以及影响因素，为ICU护理人员实施有效干预提供参考，以期减少亚谵妄综合征的发生率及其不良影响。方法遵循Arksey和O’Malley所确立的系统性文献回顾框架，检索PubMed、Web of Science、Embase、CINAHL、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库以及指南网，检索时限为建库至2024年5月5日。结果共纳入27篇文献，以前瞻性队列研究为主，共纳入3种评估工具，包括ICU患者意识模糊评估法、重症监护谵妄筛查量表和谵妄评定量表-98修订版。ICU患者亚谵妄综合征发生率较高，其主要影响因素包括患者年龄、性别、急性生理与慢性健康状况评分、手术、药物、环境等。结论医护人员应提高对亚谵妄综合征的重视，加强对其影响因素的识别筛查，防止其进展成谵妄，提升护理质量，促进患者早期康复。

关键词: 重症监护, ICU, 亚谵妄综合征, 范围综述, 护理

Abstract:

Objective To conduct a scoping review of the status on subsyndromal delirium in ICU patients at home and abroad，systematically elaborate the related concepts，assessment methods and influencing factors of this syndrome，and provide reference for ICU nursing staff to implement effective interventions，in order to reduce the incidence and adverse effects of subsyndromal delirium. Methods This study followed the framework of systematic literature review established by Arksey and O’Malley，the literature search was performed in PubMed，Web of Science，Embase，CINAHL，Cochrane Library，CNKI，Wanfang Database，VIP Database，China Biomedical Literature Database，and guideline network，with a time limit from database establishment to May 5，2024. Results A total of 27 articles were included，most were prospective studies. Three assessment tools were included，the Confusion Assessment Method of Intensive Care Unit（CAM-ICU），Intensive Care Delirium Screening Checklist（ICDSC） and Delirium Rating Scale（DRS-R98）. Higher incidence of subsyndromal delirium was observed in ICU patients. The main influencing factors included age，gender，APACHE II score，surgery，medication，environment，etc. Conclusion Medical staff should pay more attention to subsyndromal delirium，strengthen the identification and screening of its influencing factors，prevent it from progressing，so as to improve the quality of nursing and promote the early rehabilitation of patients.

Key words: Intensive Care, ICU, Subsyndromal Delirium, Scoping Review, Nursing Care

王梦倩, 刘秀梅, 康艳楠, 唐妍, 丛珊珊, 贾云艳. ICU亚谵妄综合征评估及影响因素的范围综述[J]. 中华急危重症护理杂志, 2025, 6(4): 499-505.

WANG Mengqian, LIU Xiumei, KANG Yannan, TANG Yan, CONG Shanshan, JIA Yunyan. Assessment and influencing factors of subsyndromal delirium in ICU：a scoping review[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(4): 499-505.

图/表 1

参考文献 43

[1]	Levkoff SE, Liptzin B, Cleary PD, et al. Subsyndromal delirium[J]. Am J Geriatr Psychiatry, 1996, 4(4):320-329. doi: S1064-7481(12)61533-4 pmid: 28530969
[2]	高燕, 甘秀妮, 杨睿琦, 等. 亚谵妄综合征的概念内涵及研究进展[J]. 中华护理杂志, 2021, 56(12):1883-1888. doi: 10.3761/j.issn.0254-1769.2021.12.020
	Gao Y, Gan XN, Yang RQ, et al. Conceptual connotation and research progress of subsyndromal delirium[J]. Chin J Nurs, 2021, 56(12):1883-1888. doi: 10.3761/j.issn.0254-1769.2021.12.020
[3]	Serafim RB, Soares M, Bozza FA, et al. Outcomes of subsyn-dromal delirium in ICU:a systematic review and meta-analysis[J]. Crit Care, 2017, 21(1):179.
[4]	Gao Y, Gao RQ, Yang RQ, et al. Prevalence,risk factors,and out-comes of subsyndromal delirium in older adults in hospital or long-term care settings:a systematic review and meta-analysis[J]. Geriatr Nurs, 2022,45:9-17.
[5]	Davis K, Drey N, Gould D. What are scoping studies? A review of the nursing literature[J]. Int J Nurs Stud, 2009, 46(10):1386-1400. doi: 10.1016/j.ijnurstu.2009.02.010 pmid: 19328488
[6]	王喜益, 叶志弘, 汤磊雯. 范围综述在护理领域的应用进展[J]. 中华护理杂志, 2019, 54(8):1259-1263. doi: 10.3761/j.issn.0254-1769.2019.08.030
	Wang XY, Ye ZH, Tang LW, et al. Scope review of the application progress in the nursing field[J]. Chin J of Nurs-ing, 2019, 54(8):1259-1263.
[7]	Lockwood C, Dos Santos KB, Pap R. Practical guidance for know-ledge synthesis:scoping review methods[J]. Asian Nurs Res, 2019, 13(5):287-294. doi: S1976-1317(19)30525-0 pmid: 31756513
[8]	辜甜田, 陈俊希, 杨洋, 等. 机械通气患者亚谵妄综合征风险预测模型的构建及验证研究[J]. 中华急危重症护理杂志, 2023, 4(12):1068-1074.
	Gu TT, Chen JX, Yang Y, et al. Construction and validation of a nomogram risk prediction model for subsyndromal delirium in mechanically ventilated patients[J]. Chin J Emerg Crit Care Nurs, 2023, 4(12):1068-1074.
[9]	李雪梅, 王欣琦, 徐励, 等. 脑肿瘤术后ICU患者谵妄亚型的危险因素分析[J]. 解放军护理杂志, 2022, 39(5):13-17.
	Li XM, Wang XQ, Xu L, et al. Analysis the risk factors of delirium subtypes in ICU patients after brain tumor surgery[J]. Nurs J Chin People’s Liberation Army, 2022, 39(5):13-17.
[10]	程晓雪, 石萍, 刘春兰. 急诊创伤患者亚谵妄发生预测模型的构建及验证研究[J]. 中华急危重症护理杂志, 2021, 2(6):485-490.
	Cheng XX, Shi P, Liu CL. Construction and validation of prediction model of subsyndromal delirium in emergency trauma patients[J]. Chin J Emerg Crit Care Nurs, 2021, 2(6):485-490.
[11]	Alvarez EA, Rojas VA, Caipo LI, et al. Non-pharmacological prevention of postoperative delirium by occupational therapy teams:a randomized clinical trial[J]. Front Med, 2023,10:1099594.
[12]	Mailhot T, Cossette S, Maheu-Cadotte MA, et al. Subsyndromal delirium in cardiac surgery patients:risk factors and out-comes of the different trajectories[J]. J Cardiovasc Nurs, 2022, 37(1):41-49.
[13]	Serafim RB, Dal-Pizzol F, Souza-Dantas V, et al. Impact of sub-syndromal delirium occurrence and its trajectory during ICU stay[J]. J Clin Med, 2022, 11(22):6797.
[14]	Bastos AS, Beccaria LM, Silva DCD, et al. Identification of de-lirium and subsyndromal delirium in intensive care patients[J]. Rev Bras Enferm, 2019, 72(2):463-467.
[15]	Azuma K, Mishima S, Shimoyama K, et al. Validation of the Prediction of Delirium for Intensive Care model to predict subsyndromal delirium[J]. Acute Med Surg, 2019, 6(1):54-59.
[16]	Perpetuo LH, Ferreira W, da Silva DJ, et al. Incidence rate and factors associated with delirium and subsyndromal delirium in patients with COVID-19 in an intensive care unit[J]. J Clin Med, 2023, 12(11):3789.
[17]	Cheng JN, Lao YW, Chen XP, et al. Dynamic nomogram for subsyndromal delirium in adult intensive care unit:a pros-pective cohort study[J]. Neuropsychiatr Dis Treat, 2023,19:2535-2548.
[18]	Gao Y, Gong SY, Zhou W, et al. Frequency and risk factors of subsyndromal delirium in the intensive care units:a prospective cohort study[J]. Neuropsychiatr Dis Treat, 2023, 19:1003-1016.
[19]	Legriel S, Badenes R, Engrand N, et al. Outcomes in patients with COVID-19 with acute encephalopathy and coma:an international prospective study[J]. Neurology, 2023, 100(22):e2247-e2258.
[20]	Paulino MC, Conceição C, Silvestre J, et al. Subsyndromal deli-rium in critically ill patients-cognitive and functional long-term outcomes[J]. J Clin Med, 2023, 12(19):6363.
[21]	Durlach M, Khoury M, Donato CL, et al. Delirium and subsyn-dromal delirium in the intensive care unit:In-hospital out-comes and prognosis at discharge[J]. Med Clin, 2023, 161(7):286-292.
[22]	Xing HM, Zhu SC, Liu SQ, et al. Knowledge,attitudes and practices of ICU nurses regarding subsyndromal delirium among 20 hospitals in China:a descriptive cross-sectional survey[J]. BMJ Open, 2022, 12(9):e063821.
[23]	Gao Y, Zhang CL, Liao CL, et al. Nurses’ assessment of subsy-ndromal delirium and barriers to assessment:a cross-sectional survey in the intensive care unit[J]. J Nurs Manag, 2022, 30(8):4491-4502.
[24]	Okamoto S, Ishizawa M, Inoue S, et al. Use of automated infra-red pupillometry to predict delirium in the intensive care unit:a prospective observational study[J]. SAGE Open Nurs, 2022,8:23779608221124417.
[25]	Boettger S, Nuñez DG, Meyer R, et al. Subsyndromal delirium in the intensive care setting:phenomenological characteristics and discrimination of subsyndromal delirium versus no and full-syndromal delirium[J]. Palliat Support Care, 2018, 16(1):3-13. doi: 10.1017/S1478951517000104 pmid: 28262089
[26]	Sanson G, Khlopenyuk Y, Milocco S, et al. Delirium after cardiac surgery. Incidence,phenotypes,predisposing and precipitating risk factors,and effects[J]. Heart Lung, 2018,47(4):408-417.
[27]	Yamada C, Iwawaki Y, Harada K, et al. Frequency and risk factors for subsyndromal delirium in an intensive care unit[J]. Intensive Crit Care Nurs, 2018,47:15-22.
[28]	Brummel NE, Boehm LM, Girard TD, et al. Subsyndromal deli-rium and institutionalization among patients with critical ill-ness[J]. Am J Crit Care, 2017, 26(6):447-455. doi: 10.4037/ajcc2017263 pmid: 29092867
[29]	Al-Qadheeb NS, Skrobik Y, Schumaker G, et al. Preventing ICU subsyndromal delirium conversion to delirium with low-dose IV haloperidol:a double-blind,placebo-controlled pilot study[J]. Crit Care Med, 2016, 44(3):583-591. doi: 10.1097/CCM.0000000000001411 pmid: 26540397
[30]	Klimiec E, Dziedzic T, Kowalska K, et al. PRospective Obse-rvational POLIsh Study on post-stroke delirium (PROPOLIS):methodology of hospital-based cohort study on delirium pre-valence,predictors and diagnostic tools[J]. BMC Neurol, 2015, 15:94.
[31]	Breu A, Stransky M, Metterlein T, et al. Subsyndromal delirium after cardiac surgery[J]. Scand Cardiovasc J, 2015,49(4):207-212.
[32]	Li HC, Chen YS, Chiu MJ, et al. Delirium,subsyndromal deli-rium,and cognitive changes in individuals undergoing elective coronary artery bypass graft surgery[J]. J Cardiovasc Nurs, 2015, 30(4):340-345.
[33]	Lam CY, Tay L, Chan M, et al. Prospective observational study of delirium recovery trajectories and associated short-term outcomes in older adults admitted to a specialized delirium unit[J]. J Am Geriatr Soc, 2014, 62(9):1649-1657.
[34]	Zuliani G, Bonetti F, Magon S, et al. Subsyndromal delirium and its determinants in elderly patients hospitalized for acute medical illness[J]. J Gerontol A Biol Sci Med Sci, 2013, 68(10):1296-1302.
[35]	孙建华, 郭海凌, 孙丹丹, 等. 重症患者谵妄评估的现状调查及影响因素分析[J]. 中华护理杂志, 2018, 53(1):17-21.
	Sun JH, Guo HL, Sun DD, et al. Current status and influe-ncing factors of application of the Confusion assessment me-thod for the Intensive Care Unit(CAM-ICU)[J]. Chin J Nurs, 2018, 53(1):17-21.
[36]	郑茹春, 王建宁, 陈洁, 等. ICU谵妄亚型评估及护理研究进展[J]. 护理学杂志, 2022, 37(2):101-104.
	Zheng RC, Wang JN, Chen J, et al. Assessment and nursing interventions for delirium subtypes in ICU:a review[J]. J Nurs Sci, 2022, 37(2):101-104.
[37]	Lipowski ZJ. Delirium(acute confusional states)[J]. JAMA, 1987, 258(13):1789-1792.
[38]	Leonard MM, Agar M, Spiller JA, et al. Delirium diagnostic and classification challenges in palliative care:subsyndromal delirium,comorbid delirium-dementia,and psychomotor subty-pes[J]. J Pain Symptom Manage, 2014, 48(2):199-214.
[39]	Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Deli-rium Screening Checklist:evaluation of a new screening tool[J]. Intensive Care Med, 2001, 27(5):859-864.
[40]	Almuhairi ES, Badejo M, Peer A, et al. The validity and appli-cability of the revised delirium rating scale(DRS-R98) for delirium severity assessment in a critical care setting[J]. J Intensive Care Med, 2024, 39(3):240-249.
[41]	李真, 李奇, 李尊柱, 等. ICU患者亚谵妄综合征患病率及危险因素的系统评价[J]. 中华护理杂志, 2020, 55(2):288-293. doi: 10.3761/j.issn.0254-1769.2020.02.023
	Li Z, Li Q, Li ZZ, et al. Prevalence and risk factors of subsyndromal delirium among adult intensive care unit patients:a systematic review[J]. Chin J Nurs, 2020, 55(2):288-293. doi: 10.3761/j.issn.0254-1769.2020.02.023
[42]	Wassenaar A, van den Boogaard M, van Achterberg T, et al. Multinational development and validation of an early prediction model for delirium in ICU patients[J]. Intensive Care Med, 2015, 41(6):1048-1056. doi: 10.1007/s00134-015-3777-2 pmid: 25894620
[43]	李飞, 李莉莉, 富燕萍, 等. 成人心脏术后亚谵妄综合征预测模型构建[J]. 中华现代护理杂志, 2021, 27(29):3948-3953.
	Li F, Li LL, Fu YP, et al. Construction of a predictive model of subsyndromal delirium after cardiac surgery in adults[J]. Chin J Mod Nurs, 2021, 27(29):3948-3953.