重症患者认知功能障碍发生状况及其影响因素

The Occurrence and Influencing Factors of Cognitive Dysfunction in Severe Patients

目的研究重症医学科患者认知功能障碍的发生状况;确定认知功能障碍发生的影响因素。方法选取经过川北医学院附属医院重症医学科治疗好转的患者80例(2013年12月至2015年2月)。采用简易智能精神状态量表对患者进行认知功能障碍的诊断。收集患者年龄、APACHEⅡ评分、动脉血气p H值、氧分压、二氧化碳分压、液体平衡情况、C反应蛋白、机械通气时间、住ICU时间、镇静镇痛药物用量。对认知功能障碍的影响因素进行测量,采用多元线性回归进行影响因素的分析。结果 80例经过治疗好转的重症患者中,25例发生了认知功能障碍,发生率31.25%。其中轻度9例(36%)、中度12例(48%)、重度4例(16%)。多元线性回归结果显示:年龄(b=0.539,P=0.024)、APACHEⅡ评分(b=0.155,P=0.527)、动脉血气pH值(b=0.195,P=0.046)、氧分压(b=0.080,P=0.701)、二氧化碳分压(b=0.063,P=0.791)、液体平衡情况(b=0.054,P=0.791)、C反应蛋白(b=0.049,P=0.820)、机械通气时间(b=0.053,P=0.895)、住ICU时间(b=0.029,P=0.943)、咪达唑仑用量(b=0.036,P=0.884)、芬太尼用量(b=0.102,P=0.592)。其中,年龄、pH值与认知功能障碍发生程度成负相关,具有统计学意义。结论重症患者认知功能障碍的发生率处于较高水平,中度认知功能障碍发生率占有较高比例。年龄、动脉血气pH值是认知功能障碍的主要影响因素。

Objective To study the occurrence of cognitive dysfunction in patients from department of severe medical science and to determine the influencing factors of cognitive dysfunction. Methods 80 cases （ December 2013 - February 2015 ） treated by department of severe medical of Affiliated Hospital of North Sichuan Medical College were selected. A simple mental state scale was used to diagnose the cognitive dysfunction of patients. The age, APACHE Ⅱ score, arterial blood gas pH, oxygen partial pressure, carbon dioxide partial pressure, fluid balance, C reactive protein, mechanical ventilation time, ICU time, sedative and analgesic drug dosage of patients were collected. The influencing factors of cognitive dysfunction were measured, and the influencing factors were analyzed by multiple linear regression. Results In 80 cases of severe patients who were improved by treatment, 25 cases of cognitive dysfunction occurred, and the occurrence rate was 31. 25%. Among them, mild （9 cases;36%）, moderate （12 cases;48%）, severe （4 cases;16%）. Multiple linear regression showed that age （b=0. 539, P=0. 024）, A-PACHE Ⅱ score （b=0. 155, P=0. 527） and arterial blood gas pH value （b=0. 195, P=0. 046）, the oxygen partial pressure （b=0. 080,P=0. 701）, partial pressure of carbon dioxide（b=0. 063,P=0. 791） and fluid balance （b=0. 054, P=0. 791）, C reactive protein （b=0. 049, P=0. 820） mechanical ventilation time（b=0. 053,P=0. 895 ）,live in ICU （b=0. 029,P=0. 943）, midazolam midazolam dosage （b=0. 036, P=0. 884）, fentanyl dosage（ b=0. 102, P=0. 592）. Among them, age and pH value were negatively correlated with the degree of cognitive dysfunction, and it had statistical significance. Conclusions The incidence of cognitive dysfunction in severe patients is at a high level, and the incidence of moderate cognitive dysfunction is higher in proportion. Age and pH value of arterial blood gas are the main influencing factors of cognitive dysfunction.