ICU患者亚谵妄综合征风险预测模型的系统评价

doi:10.3761/j.issn.2096-7446.2025.12.018

摘要/Abstract

摘要：

目的系统检索和评价ICU住院患者发生亚谵妄综合征的风险预测模型，以期为临床实践及相关研究提供参考。方法系统检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL、万方数据库、中国知网、维普数据库、中国生物医学文献数据库中相关研究，检索时限为建库至2024年10月12日。2名研究者分别进行文献筛选、信息提取并进行文献的方法学质量评估。结果共纳入8项研究，涉及10个模型，样本量为306~700例，结局事件发生率为8.97%~35.14%。模型报告的受试者操作特征曲线下面积均>0.7；6个模型报告了校准度；3项研究内外部验证相结合；8项研究总体适用性较好，但均存在较高的偏倚风险。结论 ICU住院患者亚谵妄综合征风险预测模型的研究尚处于起步阶段，未来的研究应完善研究设计和报告流程，并制订统一的亚谵妄综合征评估工具，进一步评估模型在临床实践中的效果和可行性。

关键词: 重症监护室, 亚谵妄综合征, 预测模型, 系统评价, 循证护理学

Abstract:

Objective To systematically search and evaluate the risk prediction models of subdelirium syndrome in hospitalized ICU patients，in order to provide reference for clinical practice and related research. Methods Relevant studies in PubMed，Web of Science，Cochrane Library，Embase，CINAHL，Wanfang Database，CNKI，VIP and CBM were searched systematically until October 12，2024. Two researchers conducted literature screening，information extraction and methodological quality assessment of the literature respectively. Results A total of 8 studies were included，involving 10 models. The sample size ranged from 306 to 700 cases，and the incidence of outcome events ranged from 8.97 to 35.14%. The area under receiver operating curve reported by the model was all >0.7. Calibration degree was reported for 6 models. Three studies performed both internal and external validation. The overall applicability of the eight studies was good，but there was a high risk of bias. Conclusion The study of risk prediction model for ICU patients with subdelirium syndrome is still in its infancy. Future studies should improve the study design and reporting process，and develop a unified subdelirium syndrome evaluation tool to further evaluate the effect and feasibility of the model in clinical practice.

Key words: ICU, Subdelirium Syndrome, Prediction Model, Systematic Evaluation, Evidence-Based Nursing

侯冲, 张沛哲, 郭锦丽, 张楠. ICU患者亚谵妄综合征风险预测模型的系统评价[J]. 中华急危重症护理杂志, 2025, 6(12): 1510-1516.

HOU Chong, ZHANG Peizhe, GUO Jinli, ZHANG Nan. A systematic review of a risk prediction models for subdelirium syndrome in ICU-hospitalized patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(12): 1510-1516.

图/表 5

参考文献 26

[1]	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.
[2]	Ma XY, Cheng HY, Zhao YR, et al. Prevalence and risk factors of subsyndromal delirium in ICU:a systematic review and meta-analysis[J]. Intensive Crit Care Nurs, 2025,86:103834.
[3]	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. doi: 10.3390/jcm12196363
[4]	Gao Y, Gao RQ, Yang RQ, et al. Prevalence,risk factors,and outcomes of subsyndromal delirium in older adults in hospital or long-term care settings:a systematic review and meta-ana-lysis[J]. Geriatr Nurs, 2022,45:9-17.
[5]	Chen SL, Tang LY, Chen J, et al. Prevalence and risk factors of subsyndromal delirium among postoperative patients:a syste-matic review and meta-analysis[J]. J Adv Nurs, 2024, 80(3):924-934. doi: 10.1111/jan.v80.3
[6]	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. doi: 10.1016/j.medcli.2023.05.012
[7]	陈茹, 王诗锋, 周吉银, 等. 预测模型研究偏倚风险评估工具(PROBAST)的介绍[J]. 中华流行病学杂志, 2020, 41(5):776-781.
	Chen R, Wang SF, Zhou JC, et al. Introduction of the predic-tion model risk of bias assessment tool:a tool to assess risk of bias and applicability of prediction model studies[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2020, 41(5):776-781.
[8]	Gao Y, Gan XN. A novel nomogram for the prediction of sub-syndromal delirium in patients in intensive care units:a pros-pective,nested case-controlled study[J]. Int J Nurs Stud, 2024, 155:104767. doi: 10.1016/j.ijnurstu.2024.104767
[9]	刘仁飞, 曹向阳, 王茜, 等. 成人骨科术后亚谵妄综合征预测模型的构建及验证[J]. 暨南大学学报(自然科学与医学版), 2024, 45(1):60-70.
	Liu RF, Cao XY, Wang Q, et al. Construction and verification of prediction model of subsyndromal delirium in adults following orthopedic surgery[J]. J Jinan Univ Nat Sci Med Ed, 2024, 45(1):60-70.
[10]	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.
[11]	张佳薪, 权明桃, 张静, 等. ICU亚谵妄综合征风险预测模型的构建及验证[J]. 中华现代护理杂志, 2023, 29(11):1453-1460.
	Zhang JX, Quan MT, Zhang J, et al. Construction and valida-tion of risk prediction model for subdelirium syndrome in ICU[J]. Chin J Mod Nurs, 2023, 29(11):1453-1460.
[12]	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.
[13]	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.
[14]	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.
[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, 2018, 6(1):54-59. doi: 10.1002/ams2.2019.6.issue-1
[16]	陈顺利, 刘琰, 陈静, 等. 老年腹部手术患者术后亚谵妄综合征预测模型的构建[J]. 中华护理杂志, 2024, 59(16):2001-2008. doi: 10.3761/j.issn.0254-1769.2024.16.012
	Chen SL, Liu Y, Chen J, et al. Construction of a predictive model for postoperative subsyndromal delirium in elderly patients undergoing abdominal surgery[J]. Chin J Nurs, 2024, 59(16):2001-2008. doi: 10.3761/j.issn.0254-1769.2024.16.012
[17]	Yao L, Li YL, Yin RY, et al. Incidence and influencing factors of post-intensive care cognitive impairment[J]. Intensive Crit Care Nurs, 2021,67:103106.
[18]	宋丽芳, 张颖惠, 王彩玲, 等. ICU谵妄严重程度的影响因素及预后研究[J]. 中华急危重症护理杂志, 2024, 5(11):978-984.
	Song LF, Zhang YH, Wang CL, et al. Study on the influencing factors and prognosis of delirium severity in intensive care units[J]. Chin J Emerg Crit Care Nurs, 2024, 5(11):978-984.
[19]	Cohen S, Meyer A, Ifrach N, et al. Physical restraint and asso-ciated agitation[J]. Nurs Crit Care, 2024, 29(5):1132-1141. doi: 10.1111/nicc.v29.5
[20]	Song J, Gao Y, Yin PB, et al. The random forest model has the best accuracy among the four pressure ulcer prediction models using machine learning algorithms[J]. Risk Manag Heal-thc Policy, 2021,14:1175-1187.
[21]	Nakagami G, Yokota S, Kitamura A, et al. Supervised machine learning-based prediction for in-hospital pressure injury development using electronic health records:a retrospective observational cohort study in a university hospital in Japan[J]. Int J Nurs Stud, 2021,119:103932.
[22]	Yan FJ, Chen XH, Quan XQ, et al. Association between the stress hyperglycemia ratio and 28-day all-cause mortality in critically ill patients with sepsis:a retrospective cohort study and predictive model establishment based on machine learning[J]. Cardiovasc Diabetol, 2024, 23(1):163. doi: 10.1186/s12933-024-02265-4
[23]	Lin SW, Lu WB, Wang T, et al. Predictive model of acute kid-ney injury in critically ill patients with acute pancreatitis:a machine learning approach using the MIMIC-Ⅳ database[J]. Ren Fail, 2024, 46(1):2303395. doi: 10.1080/0886022X.2024.2303395
[24]	Lang J. Appraisal of clinical practice guideline:clinical prac-tice guidelines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. J Physiother, 2022, 68(4):282.
[25]	Stollings JL, Kotfis K, Chanques G, et al. Delirium in critical illness:clinical manifestations,outcomes,and management[J]. Intensive Care Med, 2021, 47(10):1089-1103. doi: 10.1007/s00134-021-06503-1 pmid: 34401939
[26]	谢铃莉, 孙建华, 赵明曦, 等. ICU意识模糊评估量表与重症监护谵妄筛查量表应用效果比较的Meta分析[J]. 中华急危重症护理杂志, 2024, 5(10):944-949.
	Xie LL, Sun JH, Zhao MX, et al. Comparing CAM-ICU and ICDSC for the screening of delirium in critically ill patients:a meta-analysis[J]. Chin J Emerg Crit Care Nurs, 2024, 5(10):944-949.