镇静对谵妄影响的临床研究

A clinical study of the effects of sedation on patients with delirium

目的:探讨镇静药物和镇静水平对谵妄发生率的影响。方法:回顾性分析1 205例住院患者中发生谵妄的420例患者镇静水平,镇静药物使用情况,以及年龄、性别、平均压MAP、心率、乳酸等资料数据,分析不同镇静水平下,不同镇静药物使用情况下的谵妄发生率有无差异。结果:1 205例住院患者中有420例患者发生谵妄,使用RASS对患者的镇静深度做评估,按RASS+1 to+4、RASS-2 to 0、RASS-5 to-3划分为三种镇静深度,比较三种镇静深度下谵妄发生率,Pearsonχ~2=52.71,P=0.000;按镇静药物使用不同分为丙泊酚组、咪达唑仑组、右美托咪定组、未使用镇静剂组,比较四组患者的谵妄发生率,Pearsonχ~2=249.40,P=0.000,差异均有统计学意义(P<0.05);进一步多因素logistic回归分析结果表明镇静水平RASS(OR:1.393,95%CI:1.171~1.657)、镇静药物(OR:0.361,95%CI:0.305~0.428)、乳酸(OR:0.911,95%CI:0.854~0.971)等为谵妄的影响因素。而年龄(P=0.943)、MAP(P=0.926)、心率(P=0.745)、性别(P=0.979)等差异均无统计学意义(P<0.05)。结论:在镇静水平方面,RASS-2 to 0的镇静水平谵妄发生率最低,在镇静药物方面,右美托咪定组谵妄发生率最低,提示选择合适的镇静药物,控制在适当的镇静水平可明显减少谵妄的发生率。

Objective To explore the effects of sedative drugs and sedation level on the incidence of delirium. Method We retrospectively reviewed the data of 420 patients with delirium. The use of sedative drugs,as well as sedation level,age,sex,mean arterial pressure（ MAP）,heart rate,lactic acid and other data. We compared the incidence of delirium in patients with different levels of sedation and sedation drugs. Results We collected a total of 1 205 hospitalized patients with delirium in 420 patients and used Richmond Agitation Sedation Scale（ RASS） to assess the patient＇ s sedation depth. According to this standard（ RASS ＋ 1 to＋ 4,RASS-2 to 0,RASS-5 to-3）,and divided the patients into three groups,The incidence of delirium was compared among the three groups,Pearson chi square value of 52. 71,P = 0. 000. Then,we divided the patients into four groups（ propofol,Midazolam,Dexmedetomidine,Not used sedatives） according to the different types of sedative drugs and compared the incidence of delirium in four groups of patients,Pearson chi square value of 249. 40,P = 0. 000. Furthermore,we analyzed data by multivariate logistic regression and got the following results： Sedation level（ RASS OR： 1. 393,95% CI： 1. 171 ~ 1. 657）,sedative drugs（ OR：0. 361,95% CI： 0. 305 ~ 0. 428）,and lactic acid（ OR： 0. 911,95% CI： 0. 854 ~ 0. 971） are risk factors for delirium; On the contrary,age（ P = 0. 943）,mean arterial pressure（ MAP）（ P = 0. 926）,heart rate（ P = 0. 745）,and gender（ P = 0. 979） were not risk factors for delirium（ P〉 0. 05）. Conclusion The lowest incidence of delirium is found at RASS-2 to 0; Compared with the use of sedative drugs,the incidence of delirium is the lowest in patients who receive dexmedetomidine. We conclude that the choice of appropriate sedative drugs,controlled by appropriate sedation levels,can significantly reduce the incidence of delirium.