ICU患者亚谵妄综合征患病率及危险因素的系统评价

Prevalence and risk factors of subsyndromal delirium among adult intensive care unit patients:a systematic review

目的系统评价ICU患者亚谵妄综合征患病率现状及危险因素,为早期识别ICU患者亚谵妄综合征的发生风险提供证据支持。方法检索PubMed、Embase、PsycINFO、Cochrane Library、中国生物医学文献服务系统、中国知网、维普和万方数据库,检索时间为建库至2019年6月,纳入评价ICU患者亚谵妄综合征患病率及其影响因素的文献,应用Stata 14.0软件对亚谵妄综合征发生率进行单组Meta分析,采用固定效应或随机效应模型进行数据合并,用Begg秩相关和漏斗图判定发表偏倚。对影响因素采取描述性分析。结果共纳入13篇文献,涉及5396例ICU患者,发表时间为2007年—2019年。Meta分析结果显示,ICU患者亚谵妄综合征发生率为36.9%[95%CI(0.22~0.52)],亚组分析显示,女性、老年ICU、亚洲地区患者亚谵妄综合征患病率更高;描述性分析显示,影响ICU患者亚谵妄综合征发生的因素包括年龄、基础疾病、认知障碍、药物镇静等。结论ICU患者亚谵妄综合征发生率较高,高龄、基础疾病、认知障碍以及应用药物镇静等可增加患者发生亚谵妄综合征的风险。但纳入文献整体研究样本量不大,研究质量不高,建议后续开展多中心大样本研究,进一步探索ICU亚谵妄综合征患病率和危险因素。

Objective To determine the prevalence and risk factors of subsyndromal delirium(SSD)in adult intensive care unit patients by systematically reviewing evidence.Methods PubMed,Embase,PsycINFO,Cochrane Library,CBM,CNKI,VIP and Wanfang were searched from inception to 2019 for potentially relevant articles.Stata 14.0 software was used to analyze the prevalence of subsyndromal delirium with a single group meta-analysis.Fixed-effect or random-effect models were used to merge data.Begg rank correlation and funnel plot were used to determine publication bias.Descriptive analysis was used to analyze the influencing factors.Results 13 studies(5396 ICU patients)were included.The combined prevalence of subsyndromal delirium was 36.9%[95%CI(0.22~0.52)].Subgroup analysis showed that the prevalence of subsyndromal syndrome was higher in women,elderly ICU and patients Asia.Possible risk factors included age,severity of diseases,cognitive impairment,and drug sedation.Conclusion There is a certain prevalence of subsyndromal delirium in ICU patients(36.9%).Age,underlying diseases,cognitive impairment,and drug sedation are possible risk factors.However,the overall sample size of the study is not large and the quality of the study is quite poor.It is suggested that large-sample multi-centered studies should be carried out in future to further explore the prevalence and risk factors of subsyndromal delirium in ICU patients.