摘要： 目的 分析影响重症监护室（ICU）中危重症患者发生谵妄的危险因素。方法 回顾性收集我科收治的301例危重症患者的一般资料，包括既往史（心血管和脑血管疾病、高血压、吸烟、酗酒、糖尿病）、年龄、性别、诊断、是否手术、患者来源（急诊/平诊），以及其他可能影响谵妄发生的相关因素，包括镇静药物使用时间、Richmond躁动镇静评分量表（RASS）评分、家属探视情况、呼吸机使用时间、血管活性药物使用情况、留置引流管情况、入住ICU时间，同时记录患者入ICU 24 h内C反应蛋白、降钙素原、白细胞计数、体温、急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分和序贯性器官衰竭评估（SOFA）评分。根据ICU意识模糊评估法（CAM-ICU）评估患者有无谵妄，之后对患者的一般资料和可能影响谵妄发生的高危因素进行单因素和多因素logistic回归分析。结果 对24项与ICU患者发生谵妄相关的危险因素进行单因素logistic回归分析，结果显示，家属探视、糖尿病史和患者来源等16项危险因素与谵妄发生密切相关。进一步多因素logistic回归分析结果表明，无家属探视、有糖尿病史、急诊来源、手术术后、入住ICU时间长、有吸烟史和APACHE Ⅱ评分高是ICU危重症患者发生谵妄的独立危险因素。结论 ICU医护人员应对有糖尿病史、有吸烟史、手术术后、APACHE Ⅱ评分高和急诊转入ICU的患者给予足够重视，并增加家属探视时间，灵活探视制度，早期干预和预防，以降低ICU患者谵妄的发生率。

危重症患者发生谵妄的危险因素分析

孙智颖, 倪冬姝, 马宏飞, 常宇琨, 孙旖旎, 马晓春

中国医科大学附属第一医院重症医学科, 沈阳 110001

收稿日期:2021-08-30出版日期:2022-01-30发布日期:2021-12-30
通讯作者:孙旖旎E-mail:sunyini_1006@163.com
作者简介:孙智颖(1986-),女,护师,本科.
基金资助:辽宁省科学技术计划（2020JH2/10300010）


关键词: 危重症, 谵妄, 危险因素
Abstract: Objective To analyze the risk factors for delirium in critically ill patients in the intensive care unit (ICU). Methods We retrospectively collected the general data of 301 critically ill patients at our department, including past history (cardiovascular disease, ce- rebrovascular disease, hypertension, smoking, alcoholism, and diabetes mellitus), age, sex, diagnosis, operation status, and patient source (emergency or non-emergency). Other delirium-related factors, such as length of sedative medication, Richmond agitation-sedation scale score, family visits, ventilator use duration, use of vasoactive drugs, placement of an indwelling drainage tube, length of ICU stay, C-reactive protein and procalcitonin levels, leukocyte count, body temperature, and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) and sequential organ failure assessment scores within 24 h, were also evaluated. Delirium was assessed according to the confusion assessment method for the ICU. Thereafter, univariate and multivariate logistic regression analyses were performed to determine the risk factors for delirium. Results The results of the univariate logistic analysis of 24 factors showed that 16 risk factors were closely related to delirium. Multivariate logistic analysis showed that absence of family visits, history of diabetes mellitus, emergency department as the patient source, post-operation status, long ICU stay, history of smoking, and high APACHE Ⅱ score were independent factors for predicting delirium in the ICU. Conclusion Sufficient attention should be paid to ICU patients with history of diabetes me- llitus and smoking, post-operation status, high APACHEⅡ score, and emergency department transfer to the ICU. More strategies, such as increasing the family visit time and establishing a flexible visiting system, should be implemented for the early intervention and prevention of delirium, to decrease its incidence in the ICU.
Key words: critical illness, delirium, risk factor
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