ICU谵妄预测评分对重症监护室病人谵妄的预测价值

Predictive value of predictive score for ICU delirium for delirium in ICU patients

目的:评价ICU谵妄预测评分(PSID)对ICU病人谵妄的预测价值。方法:回顾性分析黄山首康医院重症医学科住院的133例病人的临床资料,根据病人住ICU期间是否发生谵妄分为谵妄组42例和非谵妄组91例。比较2组病人相关临床资料;采用ROC曲线分析评价PSID评分对ICU病人谵妄的预测价值,并与谵妄风险评分(DRAS)和急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分比较;采用多因素logistic回归分析评价ICU病人谵妄发生的危险因素。结果:谵妄组病人低氧血症、深镇静、苯二氮[艹卓]类药物使用和机械通气均明显高于非谵妄组(P<0.01)。PSID评分0~4分谵妄发生率为10.0%(6/60),5~9分谵妄发生率为46.3%(31/67),≥10分谵妄发生率为83.3%(5/6),PSID评分与谵妄发生率呈明显正相关关系(r=0.891,P<0.01)。PSID评分预测ICU病人谵妄发生风险的曲线下面积明显高于DRAS评分和APACHEⅡ评分(P<0.01)。多因素logistic回归分析显示,深镇静、APACHEⅡ评分、PSID评分和DRAS评分均为ICU病人谵妄发生的危险因素(P<0.05~P<0.01)。结论:PSID评分对ICU病人谵妄有较好的预测价值,分值越高出现谵妄的风险越高,值得在临床中推广使用。

Objective:To evaluate the predictive value of predictive score for ICU delirium(PSID)for delirium in ICU patients.Methods:The clinical data of 133 patients hospitalized in the department of intensive medicine of Huangshan Shoukang Hospital were retrospectively analyzed.According to whether the patients had delirium during their stay in the ICU,they were divided into a delirium group(n=42)and a non-delirium group(n=91).The related clinical data of patients between two groups were compared.ROC curve analysis was used to evaluate the predictive value of PSID score for delirium in ICU patients,which was compared with delirium risk assessment score(DRAS)and acute physiology and chronic health evaluationⅡ(APACHEⅡ).Multiple logistic regression analysis was performed to evaluate the risk factors for delirium in ICU patients.Results:Hypoxemia,deep sedation,use of benzodiazepine drug,and mechanical ventilation of patients in the delirium group were significantly higher than those in the non-delirium group(P<0.01).The incidence of delirium was 10.0%(6/60)with PSID score of 0-4 points,46.3%(31/67)with PSID score of 5-9 points,and 83.3%(5/6)with PSID score of more than 10 points.There was a significantly positive correlation between PSID score and the incidence of delirium(r=0.891,P<0.01).The area under the curve of PSID score predicting the risk of delirium in ICU patients was significantly higher than that of DRAS score and APACHEⅡscore(P<0.01).Multivariate logistic regression analysis showed that deep sedation,APACHEⅡscore,PSID score,and DRAS score were all risk factors for delirium in ICU patients(P<0.05 to P<0.01).Conclusions:PSID score has good predictive value for delirium in ICU patients,and higher score indicates higher risk of delirium,which was worthy of clinical application.