机械通气患者发生谵妄的影响因素分析

Analysis of risk factors of delirium in patients with mechanical ventilation in intensive care unit

目的探讨ICU机械通气患者发生谵妄的影响因素,并对其发生风险进行预测。方法收集2016年6月—2017年6月转入综合ICU的患者资料,用Logistic回归模型分析机械通气患者谵妄发生的危险因素,采用ROC曲线计算危险因素的曲线下面积及最佳截断值。结果共纳入398例患者,ICU机械通气患者发生谵妄163例,发生率为41.0%。Logistic回归模型结果显示,使用约束(OR=3.084)、镇静药(OR=2.255)、机械通气时长(OR=1.146)和入住ICU时长(OR=1.111)是ICU机械通气患者谵妄发生的独立预测因子。ROC曲线结果显示,使用约束、镇静药、机械通气时长、入住ICU时长的曲线下面积分别为0.580、0.566、0.787和0.774,其中机械通气时长和ICU时长的最佳截断值分别为7d和8d。结论 ICU机械通气患者谵妄发生率仍处于较高水平,使用约束、镇静药、机械通气时长>7d和入住ICU时长>8d易诱发谵妄。

Objective To explore the risk factors and predict the risk of delirium in patients with mechanical ventilation in intensive care unit（ICU）. Methods Data were collected from ICU patients hospitalized from June2016 to June 2017. Logistic regression model was used to analyze the risk factors of delirium in ICU patients with mechanical ventilation,and the ROC curve was used to calculate the area and optimal cut-off value of the curve.Results This study included 398 patients with 163 cases of delirium,and the incidence of delirium was 41.0%.Logistic regression model showed that using physical restraint（OR=3.084）,receiving sedation（OR=2.255）,duration of mechanical ventilation（OR=1.146） and ICU length of stay（OR=1.111） were independent predictors of delirium. ROC curve showed that the area under the curve was 0.580,0.566,0.787,and 0.774,respectively,and the cut-off value for mechanical ventilation duration and ICU length was 7 days and 8 days,respectively. Conclusion The incidence of delirium in ICU patients with mechanical ventilation is still high. Physical restraint,sedation,mechanical ventilation time of duration more than 7 days and ICU length of stay greater than 8 days can cause ICU delirium.