脑肿瘤术后ICU患者谵妄亚型的危险因素分析

Analysis the Risk Factors of Delirium Subtypes in ICU Patients after Brain Tumor Surgery

目的探讨脑肿瘤术后ICU患者谵妄亚型的危险因素。方法采用病例对照研究,分析2020年12月至2021年11月入住上海市某三甲医院神经外科ICU的脑肿瘤术后患者的资料,采用单因素和Logistic回归分析候选因子与各谵妄亚型间的关系。结果共纳入480例患者,145例发生谵妄(30.21%),其中活动增多型谵妄38例(26.21%)、活动减少型谵妄44例(30.34%)及混合型谵妄63例(43.45%)。Logistic回归分析发现,身体约束、手术时长是三种谵妄亚型的共同独立危险因素(均P<0.05);此外,年龄、使用苯二氮卓类药物是活动增多型谵妄的独立危险因素;经额入路开颅术、气管插管是活动减少型谵妄的独立危险因素;肿瘤直径、使用镇静药物、住ICU时长是混合型谵妄的独立危险因素。结论脑肿瘤术后ICU谵妄的发生率高,其中活动减少型谵妄占比高,且各亚型的危险因素不尽相同,启示临床应加强对谵妄亚型的识别,分层管理危险因素,降低谵妄的危害性和总体发生率。

Objective To investigate the risk factors of delirium subtype in ICU patients after brain tumor surgery.Methods A case-control study was conducted to analyze the data of postoperative patients with brain tumor admitted to the Neurosurgical ICU of a tertiary hospital in Shanghai from December 2020 to November 2021.Univariate and Logistic regression analyses were used to analyze the relationship between candidate factors and different subtypes of delirium.Results A total of 480 patients were enrolled,145 of whom developed delirium(30.21%).There were 38 cases of hyperactive delirium(26.21%),44 cases of hypoactive delirium(30.34%),and 63 cases of mixed delirium(43.45%).Logistic regression analysis showed that physical constraints and duration of surgery were common independent risk factors for the three delirium subtypes(all P<0.05).In addition,age and use of benzodiazepines were independent risk factors for hyperactive delirium.Transfrontal craniotomy and endotracheal intubation were independent risk factors for hypoactive delirium.Tumor diameter,sedative usage,and length of ICU stay were independent risk factors for mixed delirium.Conclusions The incidence of ICU delirium after brain tumor operation is high,the proportion of hypoactive delirium is high,and the risk factors of each subtype are not the same,which suggests that clinical should strengthen the identification of delirium subtype,stratified management of risk factors,and reduce the harm and overall incidence of delirium.