ICU谵妄危险因素及集束化干预预防措施

Risk factors of delirium in ICU and cluster intervention and prevention measures

目的研究重症加强护理病房(ICU)谵妄危险因素并探讨集束化干预预防措施。方法选择2016年12月至2018年12月华中科技大学同济医学院附属同济医院ICU收治的288例危重症患者为研究对象,根据ICU观察期间是否出现谵妄分为谵妄组与非谵妄组,分别为112例与176例。收集年龄、性别、疾病类型等病历资料,组间经单因素及Logistic回归分析探讨ICU谵妄的独立危险因素,并据此制定集束化干预预防措施。结果288例ICU患者发生谵妄112例,谵妄发生率38.89%;谵妄组与非谵妄组年龄、机械通气、苯二氮[艹卓]类药使用史、疾病类型、低氧血症、急性生理与慢性健康评分系统(APACHE)Ⅱ评分比较差异有统计学意义(P<0.05),两组性别、合并糖尿病、合并高血压、吸烟史比较差异无统计学意义(P>0.05);低氧血症(OR=2.076)、机械通气(OR=2.863)、苯二氮[艹卓]类药使用史(OR=2.987)、大型手术(OR=3.321)、严重创伤(OR=3.091)是ICU谵妄的独立危险因素。结论ICU谵妄发生率较高,受严重创伤、机械通气、苯二氮[艹卓]类药物、低氧血症等多种因素的影响,可根据上述循证基础制定相应的集束化干预预防措施。

Objective To study the delirium risk factors of intensive care unit(ICU)and to explore the clustering intervention prevention measures for clustering.Methods A total of 288 critically ill patients admitted to the ICU of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from December 2016 to December 2018 were selected as the study subjects.According to whether delirium occurred during ICU observation,the patients were divided into delirium group and non-delirium group,with 112 cases and 176 cases,respectively.The medical records such as age,gender,and disease type were collected.The independent risk factors of ICU delirium were investigated by univariate analysis and Logistic regression analysis between groups,and cluster intervention and prevention measures were developed based on this.Results Delirium occured in 112 of 288 ICU patients,and the incidence of delirium was 38.89%.There were significant differences in age,mechanical ventilation,benzodiazepine use history,disease type,hypoxemia,acute physiology and chronic health score(APACHE-Ⅱ)scores between the delirium group and non-delirium group(P<0.05).There was no significant difference in gender,combined diabetes mellitus,combined hypertension and smoking history between the two groups(P>0.05).Hypoxemia(OR=2.076),mechanical ventilation(OR=2.863),history of use of benzodiazepines(OR=2.987),major surgery(OR=3.321)and severe trauma(OR=3.091)were independent risk factors for ICU delirium.Conclusions The incidence of ICU delirium is high,which is affected by multiple factors such as severe trauma,mechanical ventilation,benzodiazepines,hypoxemia,etc.Therefore,appropriate cluster intervention and prevention measures can be developed based on the above evidence-based basis.