颅脑肿瘤术后ICU患者亚谵妄发生情况及影响因素研究

Incidence and influencing factors of subsyndromal delirium in ICU patients after surgery for craniocerebral tumor

目的探讨颅脑肿瘤术后ICU患者亚综合征谵妄(SSD)的发生情况并分析其影响因素.方法选取2018年1-12月入住北京某三甲医院综合ICU的患者100例为研究对象.每日运用ICU意识模糊评估法(CAM-ICU)评估患者SSD发生情况,并收集患者的一般资料以及患者的视力听力情况、简易精神状态检查表(MMSE)评分、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、机械通气情况、约束情况、氧合指数、白蛋白值、血红蛋白值、患者Na^+、Cl^-、K^+、Ca^2+等临床资料,直至患者转出ICU.采用单因素分析筛选出可能的危险因素,再采用非条件Logistic回归逐步后退法确定ICU患者SSD的独立危险因素.结果100例颅脑肿瘤术后ICU患者SSD发生率为40%(40/100),55.0%(22/40) 的SSD患者是在进入 ICU 后第 1~3天发生SSD,平均发生次数2.08次、持续时间为(30.80±10.11)h.Logistic回归分析结果显示,感染、疼痛、APACHEⅡ评分是颅脑肿瘤术后ICU患者发生SSD的独立预测因子(P<0.05).结论颅脑肿瘤术后ICU患者SSD发生率较高,有感染、疼痛、APACHEⅡ评分较高的患者容易诱发SSD.

Objective To explore the incidence of subsyndromal delirium(SSD)in ICU patients after surgery for craniocerebral tumor and its influencing factors.Methods Totally 100 patients admitted in the General Intensive Care Unit of a Class Ⅲ Grade A hospital in Beijing between January and December 2018 were selected.Confusion Assessment Model for Intensive Unit(CAM-ICU)was used to assess the incidence of SSD in these patients on a daily basis.Their clinical data,including general information,vision and listening,Mini-Mental State Examination(MMSE)scores.Acute Physiology and Chronic Health Evaluation Scoring System(APACHE Ⅱ)scores,mechanical ventilation,restraints,oxygenation index,albumin,hemoglobin,Na^+,Cl^-,K+and Ca^+values until they were transferred out of ICU.Univariate analysis was employed to screen the possible risk factors,and unconditional Logistic stepwise regression analysis was used to identify the independent risk factors of SSD in ICU patients.Results The incidence rate of SSD in the 100 ICU patients after surges for craniocerebral tumor was 40%(40/100),and 55.0%(22/40)of the patients sustained SSD since day 1-3 after admission into ICU.The average frequency of incidence was 2.08 times,anci it lasted(30.80±10.11)h.Logistic regression analysis revealed that infection,pain,APACHE Ⅱ scores were the independent predictive factors for SSD in ICU patients after surgery for rraniocerehral tumor(P<0.05).Conclusions The incidence rate of SSD in ICU patients after surgery for craniocerebral tumor is high,and infeotion,pain and high APACHE Ⅱ scores are likely to lead to SSD.