轻度创伤性颅脑损伤患者谵妄发生情况及其影响因素分析

Incidence of delirium and influencing factors in patients with mild traumatic brain injuries

目的 探讨轻度创伤性颅脑损伤患者(mTBI)谵妄的发生率及危险因素。方法 前瞻性纳入2021年1月—2023年12月在广西壮族自治区人民医院急诊科住院的107例根据《颅脑创伤临床救治指南》标准诊断为mTBI的患者,患者入院后72 h内每24h采用意识模糊评估法中文修正版(CAM-CR)进行谵妄评估,同时收集患者年龄、性别、合并疾病、入院血清钾、血清钠、血肌酐、血清白蛋白、入院24 h匹兹堡睡眠质量指数(PSQI)等临床指标。根据患者有无谵妄发生分为谵妄组和正常组,比较两组患者的相关临床指标,采用单因素分析和多因素Logistic回归分析筛选患者发生谵妄的危险因素。结果 107例mTBI患者中有41例在住院期间发生谵妄,发生率为38.32%(95%CI:22%~47.7%),谵妄组患者年龄、合并冠心病、高血压病的比例和入院24 h PSQI指数、WBC、CRP数值高于正常组,血清钠、血清钾、血清白蛋白数值低于正常组,两组比较差异有统计学意义(P均<0.05)。Logistic多因素回归分析提示年龄(OR=1.208,95%CI:1.089~1.341)、血清钠(OR=0.758,95%CI:0.624~0.920)、血清白蛋白(OR=0.755,95%CI:0.586~0.971)、入院24 h PSQI指数(OR=2.725,95%CI:1.237~6.002)是mTBI患者住院期间发生谵妄的独立影响因素(P均<0.05)。结论 年龄增加及PSQI指数增加与mTBI患者住院期间发生谵妄风险增加显著相关,血清钠浓度和血清白蛋白水平增加与mTBI患者住院期间发生谵妄风险降低显著相关。

Objective To investigate the incidence and risk factors of delirium in patients with mild trau-matic brain injuries(mTBI).Methods A total of 107 patients admitted to the Department of Emergency Medicine of the People’s Hospital of Guangxi Zhuang Autonomous Region from Jan.2021 to Dec.2023 and diagnosed as mT-BI according to the Guidelines for Clinical Treatment of Craniocerebral Trauma were prospectively included.The in-cidence of delirium was evaluated by using the Chinese Revised Version of Confusion Assessment Method(CAM-CR)every 24 h within 72 h after admission.At the same time,clinical indicators such as age,gender,comorbidity,serum potassium,sodium,creatinine,and albumin on admission,and Pittsburgh Sleep Quality Index(PSQI)at 24 h after admission were collected.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not.The relevant clinical indicators of the two groups were compared,and the risk fac-tors of delirium were screened by univariate analysis and multivariate Logistic regression analysis.Results Of the 107 mTBI patients,delirium occurred in 41 during hospitalization,with an incidence of 38.32%(95%CI:22%-47.7%).The delirium group revealed much higher age,proportions of patients with coronary heart disease or hyper-tension,PSQI at 24 h after admission,and WBC and CRP levels,while much lower levels of serum sodium,potassium and albumin,revealing significant differences when compared with the non-delirium group(all P<0.05).Logistic multivariate analysis further showed that age(OR=1.208,95%CI:1.089-1.341),serum sodium(OR=0.758,95%CI:0.624-0.920),serum albumin(OR=0.755,95%CI:0.586~0.971),and PSQI index at 24 h after admission(OR=2.725,95%CI:1.237-6.002)were independent risk factors for the incidence of delirium in mTBI patients during hospitalization(all P<0.05).Conclusion The increase of age and PSQI were significantly associated with the increased risk of delirium incidence during hospitalization of mTBI patients,while the increase of serum sodium and albumin levels was associated with decreased risk.