重症监护病房谵妄危险因素分析

Risk Factors of Delirium in ICU

目的探讨重症监护病房(ICU)谵妄的相关危险因素。方法收集符合条件的入住我院ICU的513例患者的临床资料,采用多因素Logistic回归分析性别、年龄、慢性阻塞性肺疾病(COPD)史、糖尿病史、低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用硝普钠、使用咪唑安定、感染、心律失常情况(心房纤颤、恶性心律失常、高度房室传导阻滞)、射血分数(EF)<40%、急性心血管事件、心脏介入治疗、机械通气等与ICU谵妄临床发生率的关系。结果谵妄组患者年龄、有无糖尿病史、低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、EF<40%、急性心血管事件、心脏介入及机械通气与无谵妄组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果示:低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、机械通气是ICU患者发生谵妄的危险因素(P<0.05)。结论住院患者发生低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、机械通气时,应该多观察患者,早期行谵妄的筛查,及时诊治,减少ICU患者谵妄的发生率。

Objective To explore the risk factors of delirium in ICU.Methods Clinical data of 513 eligible ICU cases were collected.Logistic regression analysis was applied to analyze the relationship between the incidence of ICU delirium and factors including gender,age,past history（COPD,diabetes）,hypotension or cardiogenic shock,hypoxia,electrolyte disturbance,sleep disturbance,drug use situation（SNP,midazolam）,infections,cases of arrhythmia,ejection fractions（EF）40%,acute cardiovascular events,cardiac interventional procedure,and mechanical ventilation.Results Age,diabetes history,hypotension or cardiogenic shock,hypoxia,electrolyte disturbance,sleep disturbance,midazolam use,infections,EF40%,acute cardiovascular events,cardiac interventional procedure,and mechanical ventilation were statistically different between the delirium group and the non-delirium group（P0.05）.Logistic regression analysis revealed that hypotension or cardiogenic shock,hypoxia,electrolyte disturbance,sleep disturbance,midazolam use,infections,and mechanical ventilation were among the risk factors of ICU delirium（P0.05）.Conclusion Inpatients with hypotension or cardiogenic shock,hypoxia,electrolyte disturbance,sleep disorders,infections,use of midazolam,and mechanical ventilation should be monitored for the purpose of early screening and prevention of delirium.