ICU精神障碍的易患因素分析

Analysis of risk factors for mental disorders in intensive care unit

目的探讨重症医学科(ICU)患者精神障碍的相关危险因素。方法收集入住ICU的患者568例,logistic回归分析冠心病史、高血压病史、酗酒史、手术史、机械通气、入ICU时间、护理质量、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分、电解质紊乱、射血分数、睡眠障碍、降钙素原、氧合指数、使用咪达唑仑、阿片类药物等与ICU精神障碍发生的关系。结果 568例患者中伴精神障碍157例,临床发生率为27.64%;男女比为1.55∶1。logistic回归分析显示,有冠心病史、高血压病史、酗酒史、手术史(特别是心脏外科术后)、机械通气、入ICU时间、护理质量、APACHEⅡ评分、电解质紊乱、睡眠障碍、降钙素原、氧合指数、使用咪达唑仑、阿片类药物是ICU患者发生精神障碍的危险因素(P均<0.05)。结论 ICU住院患者有高血压病史、酗酒史,应用机械通气、咪达唑仑时,应该严密监测与评估,早期行精神障碍的筛查,及时采取相应的防治措施;高护理质量可以明显减少ICU患者精神障碍的发生。

Objective To investigate the risk factors of mental disorders of patients hospitalized in intensive care unit（ICU）. Methods Clinical data of 568 eligible ICU cases were collected. Logistic regression analysis was applied to ana-lyze the relationship between the incidence of ICU mental disorders and factors including history of coronary heart disease,hypertension,alcohol abuse,surgery,mechanical ventilation, ICU admission time, quality of care, APACHE Ⅱ score,electrolyte imbalance, ejection fraction, sleep disorders,procalcitonin,oxygenation index,usage of midazolam or opioids.Results 157 patients out of 568 cases had mental disorders, the clinical incidence was 27.64%, the male-to-female ratio was 1.55∶1. Logistic regression analysis revealed that history of coronary heart disease, hypotension,alcohol abuse,surgery,mechanical ventilation, ICU admission time, quality of care, APACHE Ⅱ score, electrolyte imbalance, sleep disorders,procalcitonin,oxygenation index,usage of midazolam or opioids were the risk factors of ICU mental disorders（P〈0.05）.Conclusion Inpatients with hypotension,alcohol abuse, mechanical ventilation, and usage of midazolam should be monitored for the purpose of early screening and prevention of mental disorders. The high-quality care could reduce the inci-dence of mental disorders in ICU patients significantly.