CAJ | 학술논문

目的：分析非机械通气重症患者谵妄发生的危险因素。方法对2013年1月~2014年1月在本院ICU住院治疗的240例非机械通气ICU患者采用ICU意识模糊评估(CAM-ICU)法进行谵妄评估,并根据入住ICU后第一个24 h的谵妄评估结果将患者分为谵妄组和非谵妄组,比较两组患者的一般情况、基础疾病、手术部位、镇痛镇静药物和主要结果。同时通过多元Logistic回归分析找出患者入住ICU后第一个24 h谵妄的主要危险因素。结果入住ICU后第一个24 h谵妄36例(15.00%),之后4 d,每天谵妄患者分别为45例(18.75%)、76例(31.67%)、138例(57.5%)、152例(63.33%)。与非谵妄组相比院谵妄组年龄更大(t=13.59,P<0.01),急性生理和慢性健康评分(APACHEⅡ)(t=7.18,P<0.01)和C-反应蛋白(CRP)更高(t=28.04,P<0.01)；基础疾病中谵妄组脑卒中和脓毒症的比率更高(字2=36.00,P<0.01；字2=22.04,P<0.01)；手术主要部位中谵妄组创伤和急诊的比率更高(字2=13.59,P<0.01；字2=13.59,P<0.01)；镇痛镇静药物谵妄组应用咪达唑仑比率较高(字2=39.12,P<0.01),而应用右美托咪定的比率较低(字2=41.18,P<0.01)；住ICU时间和总住院时间谵妄组均多于非谵妄组(t=13.76,P<0.01；t=16.04,P<0.01),住ICU期间死亡率和住院期间死亡率谵妄组高于非谵妄组(字2=19.43,P<0.01；字2=22.81,P<0.01)。 Logistic回归分析显示,入住ICU后第一个24 h谵妄的危险因素为年龄[OR,1.24(1.14~1.26)]、APACHEⅡ评分[OR,1.36(1.18~1.38)]、咪达唑仑[OR,3.50(3.05~3.54)]、急诊手术[OR,8.76(8.62~8.80)]、创伤[OR,6.23(5.19~6.45)]和脓毒症[OR,14.05(13.28~16.03)]。结论年龄、APACHEⅡ评分、咪达唑仑、急诊手术、创伤和脓毒症是非机械通气重症患者发生谵妄的危险因素,谵妄对非机械通气重症患者有不良影响。
목적：분석비궤계통기중증환자섬망발생적위험인소。방법대2013년1월~2014년1월재본원ICU주원치료적240례비궤계통기ICU환자채용ICU의식모호평고(CAM-ICU)법진행섬망평고,병근거입주ICU후제일개24 h적섬망평고결과장환자분위섬망조화비섬망조,비교량조환자적일반정황、기출질병、수술부위、진통진정약물화주요결과。동시통과다원Logistic회귀분석조출환자입주ICU후제일개24 h섬망적주요위험인소。결과입주ICU후제일개24 h섬망36례(15.00%),지후4 d,매천섬망환자분별위45례(18.75%)、76례(31.67%)、138례(57.5%)、152례(63.33%)。여비섬망조상비원섬망조년령경대(t=13.59,P<0.01),급성생리화만성건강평분(APACHEⅡ)(t=7.18,P<0.01)화C-반응단백(CRP)경고(t=28.04,P<0.01)；기출질병중섬망조뇌졸중화농독증적비솔경고(자2=36.00,P<0.01；자2=22.04,P<0.01)；수술주요부위중섬망조창상화급진적비솔경고(자2=13.59,P<0.01；자2=13.59,P<0.01)；진통진정약물섬망조응용미체서륜비솔교고(자2=39.12,P<0.01),이응용우미탁미정적비솔교저(자2=41.18,P<0.01)；주ICU시간화총주원시간섬망조균다우비섬망조(t=13.76,P<0.01；t=16.04,P<0.01),주ICU기간사망솔화주원기간사망솔섬망조고우비섬망조(자2=19.43,P<0.01；자2=22.81,P<0.01)。 Logistic회귀분석현시,입주ICU후제일개24 h섬망적위험인소위년령[OR,1.24(1.14~1.26)]、APACHEⅡ평분[OR,1.36(1.18~1.38)]、미체서륜[OR,3.50(3.05~3.54)]、급진수술[OR,8.76(8.62~8.80)]、창상[OR,6.23(5.19~6.45)]화농독증[OR,14.05(13.28~16.03)]。결론년령、APACHEⅡ평분、미체서륜、급진수술、창상화농독증시비궤계통기중증환자발생섬망적위험인소,섬망대비궤계통기중증환자유불량영향。
Objective To analyze the risk factors of delirium in patients with severe non-mechanical ventilation. Methods Confusion assessment method for the ICU (CAM-ICU) was used for 240 patients with non-mechanical venti-lation in our hospital from January 2013 to January 2014 to assess the delirium.According to the delirium assessment results at the first 24 hours in ICU,240 cases of patients were divided into delirium group and non-delirium group.Gen-erally,the underlying disease,the surgical site,analgesic sedative drugs and the main results of the two groups was com-pared.A multiple Logistic regression was performed to identify the main risk factors for delirium in the first 24 hours after admission. Results The diagnostic rate of delirium in the first 24 hours after admission ICU was 15.00% (36 cas-es),the first four days after admission,the diagnostic rate of delirium was 18.75% (45 cases),31.67% (76 cases),57.5%(138 cases),63.33% (152 cases) respectively.Compared with non-delirium group,the age of delirium group was older (t=13.59,P<0.01),acute physiology and chronic health evaluationII (APACHEII) score (t=7.18,P<0.01) and C-reactive protein (CRP) was higher (t=28.04,P<0.01);Basic disease of stroke and sepsis ratio of delirium group was higher (χ2=36.00,P<0.01;χ2=22.04,P<0.01);Major surgical site of trauma and emergency ratio of delirium group was higher (χ2=13.59,P<0.01;χ2=13.59,P<0.01);Analgesic sedative drugs of midazolam application ratio of delirium group was higher (χ2=39.12,P<0.01),dexmedetomidine hydrochloride application ratio was lower (χ2=41.18,P<0.01);The time of ICU stay and total hospital stay of delirium group was longer (t=13.76,P<0.01;t=16.04,P<0.01),Mortality rate during the period of ICU and hospital stay was higher (χ2=19.43,P<0.01;χ2=22.81,P<0.01).Logistic regression analysis showed that,the risk factors of delirium at the first 24 hours in ICU were age [OR,1.04 (1.02-1.07)],APACHEII [OR,1.36(1.18-1.38)],mida-zolam [OR,3.50(3.05-3.54)],emergency surgery [OR,8.76(8.62-8.80)],trauma [OR,6.23(5.19-6.45)] and sepsis [OR,14.05 (13.28-16.03)]. Conclusion The risk factors of delirium in patients with severe non-mechanical ventilation are age, APACHEII,midazolam,emergency surgery,trauma and sepsis.Delirium has negatively impacts on patients with severe non-mechanical ventilation.