急诊科老年患者谵妄危险因素的系统评价

A systematic review of the risk factors of delirium in older adults in the Emergency Department

目的系统评价急诊科老年患者谵妄综合征的危险因素,为早期识别急诊科老年患者谵妄综合征的发生风险提供证据支持。方法检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、Web of Science、Cochrane Library,检索时间为建库至2021年10月6日,纳入评价急诊科老年患者谵妄综合征影响因素的观察性研究。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入25篇文献,包括17497例急诊科患者,其中谵妄患者1843例(10.5%)。Meta分析结果显示,急诊科老年患者谵妄的危险因素为高龄(>75岁)(OR=1.16,95%CI:1.05~1.29)、女性(OR=1.29,95%CI:1.08~1.54)、教育年限<6年(OR=2.80,95%CI:1.60~4.89)、居住在护理院(OR=3.40,95%CI:1.85~6.28)、精神状态改变(OR=13.86,95%CI:8.84~21.72)、有谵妄发作史(OR=3.85,95%CI:2.22~6.66)、衰弱(OR=1.63,95%CI:1.01~2.64)、存在认知障碍(OR=2.39,95%CI:1.14~5.01)、视力障碍(OR=2.08,95%CI:1.33~3.25)、听力障碍(OR=1.90,95%CI:1.07~3.35)、卒中或脑血管意外发作史(OR=1.70,95%CI:1.37~2.11)、合并痴呆症(OR=5.14,95%CI:3.87~6.84)和癫痫(OR=2.69,95%CI:1.41~5.14)。文献发表偏倚不明显。结论急诊科老年患者的谵妄与多种因素有关,护理人员应早期识别谵妄综合征危险因素,及时采取个性化干预措施。

Objective To explore the risk factors of delirium in older adults in the Emergency Department.Methods Studies were retrieved from CNKI,VIP,SinoMed,Wanfang Database,PubMed,Web of Science,and Cochrane Library from their inception to October 6,2021.Those observational studies evaluating the influencing factors of delirium in elderly patients in the Emergency Department were included.Two investigators independently screened the studies,extracted the data and evaluated the risk of bias of the included studies,RevMan 5.3 software was used for meta-analysis.Results A total of 25 articles involving 17,497 Emergency Department patients were included,including 1,843 patients(10.5%)with delirium.Meta-analysis showed that the risk factors for delirium in elderly patients in the Emergency Department were advanced age(>75)(OR=1.16,95%CI:1.05~1.29),female gender(OR=1.29,95%CI:1.08~1.54),years of education<6 years(OR=2.80,95%CI:1.60~4.89),living in a nursing home(OR=3.40,95%CI:1.85~6.28),altered mental status(OR=13.86,95%CI:8.84~21.72),history of delirium attacks(OR=3.85,95%CI:2.22~6.66),frailty(OR=1.63,95%CI:1.01~2.64),presence of cognitive impairment(OR=2.39,95%CI:1.14~5.01),visual impairment(OR=2.08,95%CI:1.33~3.25),hearing impairment(OR=1.90,95%CI:1.07~3.35),stroke or history of cerebrovascular accident(OR=1.70,95%CI:1.37~2.11),combined dementia(OR=5.14,95%CI:3.87~6.84)and epilepsy(OR=2.69,95%CI:1.41~5.14).The publication bias of the study was not significant.Conclusion Delirium in elderly patients in the Emergency Department is associated with a variety of factors,and early identification of delirium syndrome risk factors by nursing staff and implement individualized intervention timely.