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文章荐读 ICRES | 重症监护室谵妄发病率及预后的回顾性研究

已有 1696 次阅读 2021-5-21 11:42 |个人分类:文章荐读|系统分类:论文交流

小编导读

谵妄是重症监护病房(ICU)患者的常见病,但对其病因的研究较少,其危险因素因疾病而异。来自中南大学湘雅医院重症监护室和北京大学深圳医院重症监护室的研究人员在期刊Intensive Care Research (eISSN: 2666-9862)上发表了题为“The Incidence and Prognosis of ICU Delirium: A Retrospective Study from a Single Center”的文章,探讨了与重症监护病房谵妄预后相关的影响因素。

要点介绍

重症监护室(icu)是为危重病人或病情不稳定的病人提供重症监护的专科病房。由于重症监护病房患者的病情较为严重,所以谵妄是一种常见病症,发病率在11%80%之间。谵妄可导致患者延长ICU住院时间、认知功能丧失、死亡或6个月后死亡风险增加。因此,这种疾病对患者、亲属和医疗保健系统都是一种负担。

研究方法:20169月至201611月连续入住ICU的患者进行观察研究。采用Richmond躁动-镇静量表评分ICU意识模糊评估法(CAM-ICU对患者进行谵妄筛查。根据心脏/血管、脑、肺、颌面部/四肢、产科、泌尿和脊柱疾病将患者分为亚组。

研究结果:406例患者中发生谵妄186例(45.8%)。谵妄的主要原因是不同的。心脏和血管亚组谵妄的唯一危险因素是睡眠质量(比值比(OR=0.236p<0.001[0.111–0.500])。肠道疾病患者的危险因素包括年龄(OR=2.514p=0.002[1.397-4.524])、使用血管活性药物(OR=13.799p=0.002[2.669-71.361])和睡眠质量(OR=0.114p<0.001[0.036-0.366])。年龄较大(OR=1.100p=0.022[1.014-1.194])、急性生理学、年龄和慢性健康评估II评分较高(OR=1.255p<0.001[1.112-1.417])和睡眠质量(OR=0.090p=0.034[0.010-0.829])是感染性休克患者发生谵妄的危险因素。谵妄导致ICU住院时间延长(p<0.001),只有感染性休克患者的28天死亡率有差异(p=0.006)。

微信图片_20210521113823.jpg

1. 研究方案流程图。共有406名患者最终入选。纳入标准:年龄>18岁;ICU治疗>24小时。患者或近亲提供的知情同意书。排除标准:已知睡眠障碍、药物治疗精神疾病、心理问题、认知障碍、痴呆或经放射扫描诊断的中枢神经损伤。

微信图片_202105211138231.jpg

2. 不同疾病类型导致的谵妄。两名ICU临床医生每天两次评估谵妄症状。谵妄的定义是:(1)精神状态的剧烈变化或波动(2 注意力丧失(3 意识的变化;无序的思想。谵妄被认为存在于:1+2+31+2+4。谵妄患者在ICU期间出现至少一个阳性CAM-ICU时为阳性。共有186/406名患者出现谵妄。

微信图片_202105211138232.jpg

3. 不同疾病类型的有谵妄或非谵妄患者的ICU住院时间。根据材料和方法中描述的疾病类型对亚组进行分类。谵妄的评估如图1所示。A=患者队列总数;B=心脏/血管疾病患者;C=肠道疾病患者;D=肺部疾病患者;E=感染性休克患者;F=脑部疾病患者。

微信图片_202105211138233.jpg

4. 谵妄组和非谵妄组的28天死亡率。A=患者队列总数;B=心脏/血管疾病患者;C=肠道疾病患者;D=肺部疾病患者;E=感染性休克患者;F=脑部疾病患者。

研究结论:谵妄的发生率及其相关危险因素因疾病类型而异。在研究案例中,发生谵妄的感染性休克患者的28天死亡率最高。

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原文信息

Q. Feng, Y. Ai, M. Ai, L. Huang, Q. Peng, L. Zhang "The Incidence and Prognosis of ICU Delirium: A Retrospective Study from a Single Center", Intensive Care Research, 2021, DOI: 10.2991/icres.k.210206.001.

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Intensive Care Research旨在发表重症医学相关的医疗、护理、管理等方面的指南/专家共识、原创性研究、病例分析、综述等,为全球范围内重症和重症监护医学的相关学科提供一个交流最新成果、想法和发现的平台。更多期刊主题详见:https://www.atlantis-press.com/journals/icres/aims-and-scope 

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