ICU病人突发谵妄的防控机制研究

Study on the best prevention mechanism for sudden delirium in ICU patients

目的:分析ICU病人突发谵妄的主要危险因素,构建logistic回归模型和决策树模型,并进行前瞻性验证,为临床建立早期识别谵妄发生的最佳防控机制。方法:随机选取2018年1月至2020年1月病人198例为模型组,开展回顾性分析,根据24 h内谵妄诊断标准分为谵妄88例和无谵妄110例,多因素logistic回归分析筛选危险因素。另选择2020年2月至2021年2月87例病人为验证组,受试者工作特征曲线(ROC)比较2种模型的预测效能。结果:与无谵妄病人相比,谵妄病人的年龄、急性生理与慢性健康(APACHEⅡ)评分和并发症增加,镇静时间和机械通气时间延长,血清神经烯醇化酶(NSE)和动脉血乳酸升高,氧合指数降低(P<0.01)。logistic回归分析显示,APACHEⅡ评分高、血清NSE和动脉血乳酸水平高是谵妄发生的独立危险因素(P<0.01)。分别构建logistic回归模型和决策树模型,经验证组ROC分析显示,决策树模型的曲线下面积0.865高于logistic回归模型的0.812(P<0.01)。结论:ICU病人24 h内突发谵妄的发生率较高,多个危险因素可能参与了谵妄的发生,包括APACHEⅡ评分、血清NSE和动脉血乳酸水平升高,决策树模型比传统logistic回归模型可能具有更高的预测效能,可为指导临床医护人员早期正确识别谵妄高风险群体提供了更佳的评估手段。

Objective:To analyze the main risk factors of sudden delirium in ICU patients,construct logistic regression model and decision-tree model through a prospective verification to establish the best prevention mechanism for early identification of delirium.Methods:A total of 198 ICU patients from January 2018 to January 2020 were retrospectively summarized as the model group.According to the diagnostic criteria of delirium within 24 hours,they were divided into delirium group(n=88)and non-delirium group(n=110).The risk factors were screened by multivariate logistic regression analysis.In addition,87 patients from February 2020 to February 2021 were choosed as the validation group.Receiver operating characteristic curve was used to compare the predictive efficacy of the two models.Results:Compared with the patients without delirium,the age,acute physiology and chronic health(APACHEⅡ)score and complications of the patients with delirium were increased,sedation time and mechanical ventilation time were prolonged,serum neuro-specific enolase(NSE)and arterial blood lactic acid were increased,and oxygenation index was decreased(P<0.01).Logistic regression analysis showed that APACHEⅡ score,serum NSE and arterial blood lactate level were independent risk factors for delirium(P<0.01).The area under the curve of the decision-tree model was higher than that of logistic regression model(P<0.01).Conclusions:The incidence of sudden delirium within 24 hours in ICU patients is high,and multiple risk factors may be involved in the occurrence of delirium,including APACHEⅡ score,serum NSE and arterial blood lactic acid level.The decision-tree model may have a higher predictive efficacy than traditional logistic regression model,which provides a better evaluation method for guiding clinical medical staff to correctly identify high-risk groups of delirium in early stage.