非机械通气重症患者发生谵妄的危险因素分析

Risk factors of delirium in patients with severe non-mechanical ventilation

目的分析非机械通气重症患者谵妄发生的危险因素。方法对2013年1月~2014年1月在本院ICU住院治疗的240例非机械通气ICU患者采用ICU意识模糊评估（CAM-ICU）法进行谵妄评估,并根据入住ICU后第一个24 h的谵妄评估结果将患者分为谵妄组和非谵妄组,比较两组患者的一般情况、基础疾病、手术部位、镇痛镇静药物和主要结果。同时通过多元Logistic回归分析找出患者入住ICU后第一个24 h谵妄的主要危险因素。结果入住ICU后第一个24 h谵妄36例（15.00%）,之后4 d,每天谵妄患者分别为45例（18.75%）、76例（31.67%）、138例（57.5%）、152例（63.33%）。与非谵妄组相比：谵妄组年龄更大（t=13.59,P〈0.01）,急性生理和慢性健康评分（APACHEⅡ）（t=7.18,P〈0.01）和C-反应蛋白（CRP）更高（t=28.04,P〈0.01）;基础疾病中谵妄组脑卒中和脓毒症的比率更高（χ^2=36.00,P〈0.01;χ^2=22.04,P〈0.01）;手术主要部位中谵妄组创伤和急诊的比率更高（χ^2=13.59,P〈0.01;χ^2=13.59,P〈0.01）;镇痛镇静药物谵妄组应用咪达唑仑比率较高（χ^2=39.12,P〈0.01）,而应用右美托咪定的比率较低（χ^2=41.18,P〈0.01）;住ICU时间和总住院时间谵妄组均多于非谵妄组（t=13.76,P〈0.01;t=16.04,P〈0.01）,住ICU期间死亡率和住院期间死亡率谵妄组高于非谵妄组（χ^2=19.43,P〈0.01;χ^2=22.81,P〈0.01）。Logistic回归分析显示,入住ICU后第一个24 h谵妄的危险因素为年龄[OR,1.24（1.14~1.26）]、APACHEⅡ评分[OR,1.36（1.18~1.38）]、咪达唑仑[OR,3.50（3.05~3.54）]、急诊手术[OR,8.76（8.62~8.80）]、创伤[OR,6.23（5.19~6.45）]和脓毒症[OR,14.05（13.28~16.03）]。结论年龄、APACHEⅡ评分、咪达唑仑、急诊手术、创伤和脓毒症是非机械通气重症患者发生谵妄的危险因素,谵妄对非机械通气重症患者有不良影响。

Objective To analyze the risk factors of delirium in patients with severe non-mechanical ventilation.Methods Confusion assessment method for the ICU（CAM-ICU） was used for 240 patients with non-mechanical ventilation in our hospital from January 2013 to January 2014 to assess the delirium.According to the delirium assessment results at the first 24 hours in ICU,240 cases of patients were divided into delirium group and non-delirium group.Generally,the underlying disease,the surgical site,analgesic sedative drugs and the main results of the two groups was compared.A multiple Logistic regression was performed to identify the main risk factors for delirium in the first 24 hours after admission. Results The diagnostic rate of delirium in the first 24 hours after admission ICU was 15.00%（36 cases）,the first four days after admission,the diagnostic rate of delirium was 18.75%（45 cases）,31.67%（76 cases）,57.5%（138 cases）,63.33%（152 cases） respectively.Compared with non-delirium group,the age of delirium group was older（t=13.59,P0.01）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score（t=7.18,P0.01） and C-reactive protein（CRP） was higher（t =28.04,P〈0.01）;Basic disease of stroke and sepsis ratio of delirium group was higher（χ^2=36.00,P〈0.01;χ2=22.04,P〈0.01）;Major surgical site of trauma and emergency ratio of delirium group was higher（χ^2=13.59,P〈0.01;χ2=13.59,P〈0.01）;Analgesic sedative drugs of midazolam application ratio of delirium group was higher（χ^2=39.12,P0.01）,dexmedetomidine hydrochloride application ratio was lower（χ^2=41.18,P0.01）;The time of ICU stay and total hospital stay of delirium group was longer（t=13.76,P0.01;t=16.04,P〈0.01）,Mortality rate during the period of ICU and hospital stay was higher（χ2=19.43,P〈0.01;χ^2=22.81,P〈0.01）.Logistic regression analysis showed that,the risk factors of delirium at the first 24 hours in ICU were age [OR,1.04（1.02-1.07）],APACHEⅡ [OR,1.36（1.18-1.38）],midazolam [OR,3.50（3.05-3.54）],emergency surgery [OR,8.76（8.62-8.80）],trauma [OR,6.23（5.19-6.45）] and sepsis [OR,14.05（13.28-16.03）]. Conclusion The risk factors of delirium in patients with severe non-mechanical ventilation are age,APACHE Ⅱ,midazolam,emergency surgery,trauma and sepsis.Delirium has negatively impacts on patients with severe non-mechanical ventilation.