ICU谵妄持续时间及影响因素的研究

发布时间：2018-01-13 21:22

  本文关键词：ICU谵妄持续时间及影响因素的研究　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

  更多相关文章： ICU谵妄 持续时间 抗精神病药物 缺氧 谵妄类型

【摘要】：研究背景:ICU谵妄是由于ICU病人经历的一系列打击所致的一种中枢神经系统的急性功能障碍,有关ICU谵妄发生的危险因素,已有研究对其进行了探索并进行了相应预防措施的实施,然而其发生率仍高达35%-80%。ICU谵妄发生之后,危害度极大,严重影响了患者预后,给患者带来一系列不良的近期影响及远期影响。ICU谵妄持续时间与危害度正相关,而国外仅有少量研究描述谵妄持续时间,但并未对影响ICU谵妄持续时间的因素进行探讨,国内亦没有相关研究,因此ICU谵妄发生后,本研究对其持续时间进行描述,并对影响ICU谵妄持续时间因素进行探究。研究目的:(1)描述ICU谵妄患者的谵妄持续时间;(2)探究影响ICU谵妄患者谵妄持续时间的因素。研究方法:选取北京协和医院重症医学科2016年4月-2016年12月期间发生ICU谵妄的患者作为研究对象。于患者首次发生谵妄后,收集患者一般资料以及机械通气、镇静镇痛药物使用、抗精神病药物使用、缺氧、感染、内环境、谵妄类型等临床资料,记录对患者所采取的谵妄管理措施,至患者谵妄评估为阴性或患者转出ICU。通过Kaplan-Meier单因素分析和Cox多因素分析探讨ICU谵妄持续时间的影响因素。结果:(1)从2016年4月至2016年12月,共对870名转入ICU的患者进行谵妄评估,筛查出谵妄患者77例,ICU谵妄发生率为8.9%。研究对象年龄范围为32-83岁,平均年龄61.81±12.84岁。ICU谵妄持续时间平均为(5.06±4.59)天,中位持续时间为4天。ICU谵妄总体评分呈平稳趋势,在5天之内波动于4.06至4.46之间。(2)单因素分析显示,年龄、APACHEⅡ评分、谵妄类型A(镇静相关谵妄或持续性谵妄)、谵妄类型B(安静型谵妄、躁动型谵妄或混合型谵妄)、机械通气时间、内环境紊乱时间、缺氧时间、感染时间、抗精神病药物使用时间以及ABCDEF集束策略的实施数目等因素组间整体比较有显著差异。(3)Cox回归分析显示,APACHEⅡ评分、谵妄类型A、缺氧时间以及抗精神病药物使用时间(χ2=4.670,P=0.031;x2=5.801,P=0.016;χ2=14.438,P0.001;χ2=13.360,P0.001)为 ICU谵妄持续时间的影响因素。结论:ICU谵妄发生率为8.9%,平均持续时间为(5.06±4.09)天,持续时间与APACHE Ⅱ评分、谵妄类型A、缺氧时间以及抗精神病药物使用时间相关。医护人员应对病情严重程度高、持续性谵妄、存在缺氧的患者加强谵妄管理,并慎用抗精神病药物,以尽可能降低谵妄持续时间,改善患者预后。
[Abstract]:Background: delirium in ICU is an acute central nervous system dysfunction caused by a series of blows experienced by patients with ICU, and is associated with risk factors for the development of delirium ICU. It has been explored and preventive measures have been carried out, but the incidence of delirium is still as high as 35-80. After the occurrence of delirium in ICU, the degree of harm is great, which seriously affects the prognosis of patients. The duration of delirium in ICU was positively correlated with the severity of delirium, while only a few studies in foreign countries described the duration of delirium. However, the factors affecting the duration of ICU delirium were not discussed, and there were no related studies in China. Therefore, after the occurrence of ICU delirium, this study described the duration of ICU delirium. To investigate the factors affecting the duration of ICU delirium. Objective: to describe the duration of delirium in patients with ICU delirium. 2). To explore the factors affecting the duration of delirium in patients with ICU delirium. The patients with delirium ICU from April 2016 to December 2016 in Peking Union Hospital were selected as the study subjects after the first occurrence of delirium. To collect the general information of patients, mechanical ventilation, sedative and analgesic drug use, antipsychotic drug use, hypoxia, infection, internal environment, delirium type and other clinical data, and record the management of delirium. Kaplan-Meier univariate analysis and Cox multivariate analysis were used to study the influencing factors of the duration of delirium in ICU. From April 2016 to December 2016. A total of 870 patients transferred to ICU were evaluated for delirium, and 77 cases of delirium were screened. The incidence of delirium in ICU was 8.9 years old. The age range of the study was 32-83 years. The mean age was 61.81 卤12.84 years. The average duration of delirium in ICU was 5.06 卤4.59) days, and the median duration was 4 days. The overall score of delirium in ICU showed a stable trend. Univariate analysis showed that age was associated with Apache 鈪，

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