ICU谵妄危险因素的Meta分析

A Meta-analysis of the risk factors of delirium in ICU

目的通过Meta分析明确ICU谵妄的危险因素。方法通过进行文献质量评价,应用RevMan 4.2分析软件进行敏感性和异质性分析,并采用固定效应或随机效应模型计算合并后的综合效应。结果10篇文献符合纳入标准,共纳入ICU谵妄危险因素21个,仅酒精滥用、呼吸系统疾病、感染、APACHEⅡ、尿素氮升高、低钠血症、高胆红素血症和使用镇静剂具有综合效应,为ICU谵妄的独立预测因子。结论感染、代谢异常或障碍,以及药物作用和酒精戒断作用是ICU谵妄的独立预测因子,而通常被认为是ICU谵妄危险因素的高龄和缺氧,证据尚不充分。

Objective To identify the risk factors of delirium in ICU by Meta-analysis. Methods Quality of the studies was assessed in terms of study design,definitions of main variables, statistics ,and bias control. Analysis of sensitivity and heterogeneity were performed and cumulative effects were calculated using either fixed or random effects models by RevMan 4.2. Results Ten studies met all inclusive and exclusive criteria. Simple sizes range from 100 to 3308. Twenty-one risk factors of delirium in ICU were involved,but only alcohol abuse,respiratory disease,infection,APACHE II ,elevated level of serum urea nitrogen,hyponatremia,hyperbilirubinemia and using sedatives were identified as having a cumulative effect on delirium in ICU. Conclusions Infection,abnormality or disturbance of metabolism and intoxication or acute withdrawal from drug or alcohol are independent predictors of delirium in ICU,while advanced age and hypoxemia,which are commonly considered as independent risk factors of delirium in ICU,are still inconclusive.