心力衰竭患者谵妄发生现状及其影响因素的研究

Study on the Prevalence and Risk Factors of Delirium in Hospitalized Patients With Heart Failure

目的:探讨谵妄在心力衰竭患者中的发生率及其影响因素。方法:前瞻性观察研究来自中国医学科学院阜外医院心力衰竭治疗中心2017年8月至2018年5月收治住院的患者323例。根据纳入和排除标准对最终入选的318例患者在住院期间是否发生谵妄,分为谵妄组(n=12)和非谵妄组(n=306)。采用重症监护谵妄筛查量表(ICDSC)每日2次对患者住院期间是否发生谵妄进行筛查,描述心力衰竭患者住院期间谵妄发生现状并分析影响患者谵妄发生的因素。结果:318例患者中有12例(3.8%)发生了谵妄。研究发现患者的血钠>145 mmol/L(OR=18.349,P<0.001)、血肌酐>133μmol/L(OR=7.246,P=0.009)以及使用镇静安眠药(OR=6.427,P=0.010)是心力衰竭患者发生谵妄的独立影响因素。结论:医务人员对伴有谵妄发生高危因素的患者,应提前干预并增加有效监测;对心力衰竭患者使用镇静安眠药物缓解患者焦虑失眠等症状时应慎重,可依据循证证据使用心理护理、中医缓和疗法等替代疗法,从而有效减少患者谵妄症状的发生,改善患者预后。

Objectives:To investigate the prevalence and risk factors of delirium in hospitalized patients with heart failure.Methods:We performed a prospective observational study to examine the prevalence of delirium in hospitalized heart failure patients during August 2017 to May 2018.We used the Intensive Care Delirium Screening Checklist(ICDSC)to access the presence of delirium.Results:318 hospitalized heart failure patients were enrolled into the study,and delirium developed in 12 patients(3.8%)during hospitalization.Multivariate analysis indicated that sodium>145 mmol/L(OR=18.349,P<0.001),creatinine>133μmol/L(OR=7.246,P=0.009)and using sedative-hypnotic drugs(OR=6.427,P=0.010)were the independent determinants of delirium in patients with heart failure.Conclusions:In hospitalized heart failure patients with above risk factors,we should formulate intervention measures and strengthen careful monitoring,sedative-hypnotic drugs use should be applied with caution.Evidence-based treatment like psychological nursing,traditional Chinese medicine palliative therapy and so on should be considered to relieve patients'anxiety symptom such as insomnia to reduce the occurrence of delirium and improve the prognosis.