RICU患者发生谵妄的病因分析

Clinical Features and Etiology of Patients with Delirium in Respiratory Intensive Care

目的探讨呼吸重症监护病房(respiratory intensive care unit,RICU)中患者出现谵妄的病因。方法对2010-06/2012-06月在作者医院RICU住院期间出现谵妄的患者进行回顾性分析,同期随机抽取相同例数未出现谵妄的患者作为对照组,进行比较分析。结果住院期间出现谵妄的患者共30例,发生率为8.2%(30/362),年龄多在70岁以上,男女无明显差异。由原发病引起的谵妄占53.3%(16/30),其中以肺部感染、慢性阻塞性肺疾病、呼吸衰竭、心力衰竭多见,40%患者需要机械通气。药物因素引起的谵妄占33.3%(10/30),以喹诺酮类、糖皮质激素类、茶碱类药物多见。由个人因素和ICU环境因素引起的谵妄占13.3%(4/30)。与对照组比较,谵妄组病死率无明显增加,但住院时间长[(16±5)d vs.(12±4)d,P<0.05],住院费用高。结论通过积极处理原发病,去除诱因及有针对性地对患者进行心理疏导,有助于降低RICU谵妄发生率。

Objective To investigate the clinical features, etiology of patients with delirium in respiratory intensive care unit （RICU）. Methods Patients with delirium during respiratory intensive care unit （RICU） hospitalization in the authors＇ hospital between July 2010 and January 20!2 were studied. The same amount of the patients without delirium at the same hospitalization time were randomly collected as control. The clinical data were retrospectively analyzed and com- pared. Results The ineidenee of delirium was 8.2%（30/362）. Most delirium patients were older than 70 years, and there was no significant difference between different genders. 53.3% （16/30） delirium were induced by primary disease, inclu- ding lung infeetions,ehronie obstructive pulmonary disease （COPD）, respiratory failure, heart failure, etc. 40% delirium received mechanical ventilation. 33. 3% （10/30） delirium were associated with medication, including quinolone, glucocor ticoid and theophylline. 13.3 % （4/30） were associated with ICU environment and other factors. Compared with the con- trol group, the mortality of the delirium patients was not signifieantly increased, but had longer hospital stay [（16± 5）d vs. （12±4）d, P〈0.05] and higher hospitalization cost. Conclusion Comprehensive treatment of the primary disease, removal of the relevant aggravating factors, mental intervention of the patients can reduce the incidence of delirium of pa- tients in RICU.