ICU患者谵妄亚型、发生及持续时间的调查研究

Subtype, incidence and duration of delirium among intensive care unit patients

目的 分析ICU谵妄的亚型和谵妄发生及持续的时间。方法 前瞻性收集2015年10月— 2017 年9 月入住浙江省金华市中心医院ICU 符合纳入标准的516 例患者的基线资料，采用ICU 意识错乱评估方法（CAM-ICU）对患者进行评估，分析谵妄的亚型，比较谵妄发生及持续的时间。结果 516 例患者中119 例发生谵妄，发生率为23.06％。其中活动增多型谵妄14 例，活动减少型谵妄61 例，混合型谵妄44 例。79.83% 的患者首次发生谵妄在入住ICU 的2～5 d，夜间谵妄的发生率为63.87%，谵妄持续时间2～3 d 患者占52.94%。3 组亚型间谵妄发生的时间段比较差异有统计学意义（χ^2=11.116，P= 0.025）。3 组亚型间谵妄持续时间比较，差异有统计学意义（H=24.728，P＜ 0.001）。结论 患者入住ICU 后的第2～5天是谵妄的高发期，谵妄发生时间段有波动性，呈昼轻夜重的特点。应加强对患者谵妄评估，尽早识别谵妄，及时采取措施，以降低ICU 谵妄发生的风险和缩短谵妄持续的时间。

Objective To explore the subtype, incidence and duration of delirium in intensive care unit （ICU）. Methods From October 2015 to September 2017, we prospectively collected baseline information of 516 inpatients met the inclusion criteria of ICU in Jinhua Municipal Central Hospital of Zhejiang Province. We assessed patients with the Confusion Assessment Method for the intensive Care Unit （CAM-ICU）, and analyzed subtype of delirium and compared the incidence and duration of delirium. Results Among 516 patients, there were 119 eases with delirium along with 23.06% for the incidence. There were 14 eases with delirium in the type of increased activities, 61 eases with delirium in the type of decreased activities and 44 eases with delirium in the mixed type. Delirium of 79.83% of patients occurred for the first time when being admitted to ICU between the second day and fifth day with 63.87% for the incidence of delirium night. The duration of delirium was from two to three days accounting for 52.94%. There were statistieal differences in the occurrence time of delirium with three subtypes （χ^2= 11.116, P=0.025）. The differences in duration of delirium with three subtypes were also significant （H=24.728, P 〈 0.001）. Conclusions Patients＇ high-incidence period of delirium is from the second day to the fifth day after being admitted to ICU. The occurrence time of delirium has the volatility showing the characteristic of light daytime and heavy night. We should strengthen assessment for delirium of patients to identify and take steps early, so as to reduce the occurrence risk of ICU delirium and shorten the duration of delirium.