ICU谵妄严重程度的影响因素及预后研究

Study on the infuencing factors and prognosis of delirium severity in intensive care units

目的调查ICU谵妄的严重程度,分析其影响因素,探讨对患者预后的影响。方法纳入2022年9月一2023年9月入住山西省太原市某三级甲等医院综合ICU的患者410例,将其分为亚谵妄组、轻中度谵妄组和重度谵妄组,收集相关资料并于出院90d后随访。采用多因素Logistic回归分析谵妄严重程度的影响因素,采用Kaplan-Meier法绘制患者出院后90d的累积生存曲线并进行Log-rank检验。结果ICU谵妄发生率为36.77%;谵妄严重程度占比中,亚谵妄占32.20%,轻中度谵妄占47.32%,重度谵妄占20.48%。以亚妄为参照,年龄是轻中度谵妄的危险因素;机械通气时间是重度谵妄的危险因素;苯二氮草类药物使用、降钙素原、急性生理与慢性健康评分Ⅱ(Acute Physiology And Chronic Health EvaluationⅡ,APACHEⅡ)、胃肠功能分级是谵妄严重程度的危险因素(P<0.05);不同谵妄严重程度患者出院后90d病死率有影响。

Objective e To investigate the severity of delirium in ICU,analyze its influencing factors,and explore the influence on the prognosis of patients.Methods A total of 410 patients admitted to the general ICU of a tertiary class A hospital in Taiyuan,Shanxi province from September 2022 to September 2023 were included,the patients were divided into subdelirium group,mild-moderate delirium group and severe delirium group.The related data were collected and the patients were followed up for 90 days after discharge.Multivariate logistic regression was used to analyze the factors influencing the severity of delirium.Kaplan-Meier method was used to plot the 90-day cumulative survival curve and Log-rank test was performed.Results The incidence of delirium was 36.77%.Subdelirium,mild to moderate delirium and severe delirium accounted for 32.20%,47.32%and 20.48%.Taking delirium as a reference,age was a risk factor for mild to moderate delirium,mechanical ventilation time was a risk factor for severe delirium.The use of benzodiazepines,procalcitonin,APACHE I score,and gastrointestinal function grading were risk factors for the severity of delirium(P<0.05).The 90-day mortality were significantly different among the patients with different delirium severity(P<0.05).Conclusion The incidence of delirium in ICU patients was high,mainly mild to moderate delirium.Older age,higher APACHE II score,longer duration of mechanical ventilation,higher procalcitonin levels,gastrointestinal dysfunction,and use of benzodiazepine were associated with more severe delirium.The severity of delirium affected the 90-day mortality after discharge.