ICU谵妄严重程度的影响因素及预后研究

doi:10.3761/j.issn.2096-7446.2024.11.003

摘要/Abstract

摘要： 目的调查ICU谵妄的严重程度,分析其影响因素,探讨对患者预后的影响。方法纳入2022年9月—2023年9月入住山西省太原市某三级甲等医院综合ICU的患者410例,将其分为亚谵妄组、轻中度谵妄组和重度谵妄组,收集相关资料并于出院90 d后随访。采用多因素Logistic回归分析谵妄严重程度的影响因素,采用Kaplan-Meier法绘制患者出院后90 d的累积生存曲线并进行Log-rank检验。结果 ICU谵妄发生率为36.77%;谵妄严重程度占比中,亚谵妄占32.20%,轻中度谵妄占47.32%,重度谵妄占20.48%。以亚谵妄为参照,年龄是轻中度谵妄的危险因素;机械通气时间是重度谵妄的危险因素;苯二氮䓬类药物使用、降钙素原、急性生理与慢性健康评分Ⅱ（Acute Physiology And Chronic Health Evaluation Ⅱ,APACHE Ⅱ）、胃肠功能分级是谵妄严重程度的危险因素（P<0.05）;不同谵妄严重程度患者出院后90 d病死率差异有统计学意义（P<0.05）。结论 ICU谵妄发生率较高,以轻中度谵妄为主;高龄、APACHE Ⅱ评分高、机械通气时间长、降钙素原浓度高、胃肠功能障碍以及使用苯二氮䓬类药物的患者更容易出现较严重的谵妄;谵妄严重程度对患者出院后90 d病死率有影响。

关键词: 重症监护病房, 谵妄, 严重程度, 危险因素, 预后, 护理

Abstract: Objective To investigate the severity of delirium in ICU,analyze its influencing factors,and explore the influence on the prognosis of patients. Methods A total of 410 patients admitted to the general ICU of a tertiary class A hospital in Taiyuan,Shanxi province from September 2022 to September 2023 were included,the patients were divided into subdelirium group,mild-moderate delirium group and severe delirium group. The related data were collected and the patients were followed up for 90 days after discharge. Multivariate logistic regression was used to analyze the factors influencing the severity of delirium. Kaplan-Meier method was used to plot the 90-day cumulative survival curve and Log-rank test was performed. Results The incidence of delirium was 36.77%. Subdelirium,mild to moderate delirium and severe delirium accounted for 32.20%,47.32% and 20.48%. Taking delirium as a reference,age was a risk factor for mild to moderate delirium,mechanical ventilation time was a risk factor for severe delirium. The use of benzodiazepines,procalcitonin,APACHE Ⅱ score,and gastrointestinal function grading were risk factors for the severity of delirium（P<0.05）. The 90-day mortality were significantly different among the patients with different delirium severity（P<0.05）. Conclusion The incidence of delirium in ICU patients was high,mainly mild to moderate delirium. Older age,higher APACHE Ⅱ score,longer duration of mechanical ventilation,higher procalcitonin levels,gastrointestinal dysfunction,and use of benzodiazepine were associated with more severe delirium. The severity of delirium affected the 90-day mortality after discharge.

Key words: Intensive Care Units, Delirium, Severity, Risk Factors, Prognosis, Nursing Care

宋丽芳, 张颖惠, 王彩玲, 张丽玉, 武彩红, 乔晓霞. 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 Lifang, ZHANG Yinghui, WANG Cailin, ZHANG Liyu, WU Caihong, QIAO Xiaoxia. Study on the influencing factors and prognosis of delirium severity in intensive care units[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(11): 978-984.

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