ICU患者谵妄危险模型的建立及代谢组学分析

发布时间：2018-02-09 07:52

本文关键词： 谵妄发生率危险因素代谢组学　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨ICU谵妄患者的危险因素及相关差异标志代谢物。方法回顾分析皖南医学院弋矶山医院重症监护病房(ICU)2014年09月至2016年01月16个月(推导组)住院超过24小时的223例患者。每天采用CAM-ICU法对患者进行两次评估,并将患者分为谵妄组与非谵妄组。采用单因素和多因素logistic回归对高血压病史等23个因素与谵妄发生之间的关系进行分析。多因素分析得出危险因素模型后,前瞻性收集2016年02月至2016年09月7个月(验证组)81例患者的临床资料并进行验证。再配对选择36例谵妄与无谵妄患者,取静脉血2ml,行1H NMR检测分析两组血清代谢组学的差异。结果:1.全部304例患者,其中推导组223例,验证组81例,共64例患者发生了谵妄,发生率为21.1%。推导组多因素分析发现有高血压病史(RR=4.367;P=0.020)、低氧血症(RR=3.382;P=0.018)、苯二氮卓类药物的使用(RR=5.503;P=0.013)、深度镇静(RR=3.339;P=0.048)、感染(RR=3.480;P=0.008)和机械通气(RR=3.547;P=0.037)是ICU患者发生谵妄的独立危险因素。危险模型预测ICU患者发生谵妄的准确性在推导组为0.862,在验证组为0.739。验证组的预计ICU患者谵妄发生率与实际发生率相比无统计学差异(P0.05)。2.代谢组学检测发现无谵妄组患者与谵妄组患者相比,异亮氨酸、亮氨酸、缬氨酸、丙氨酸、和乙酰乙酸的峰值明显增高,而柠檬酸的峰值则明显降低。结论:1、本研究成功构建了ICU谵妄预测模型2、代谢组学研究结果显示ICU谵妄患者氨基酸代谢、三羧酸循环和酮体代谢异常
[Abstract]:Objective to explore the risk factors of delirium in ICU patients and related differences in marker metabolites. Methods a retrospective analysis of Wangnan Medical College yijishan hospital ICU (ICU) from 2014 09 to 2016 01 months 16 months (derived group) 223 cases of hospitalized patients with more than 24 hours. Using CAM-ICU method, two times a day to assess the patients, and the patients were divided into delirium group and non delirium group. Using single factor and multi factor Logistic regression on the relationship between hypertension and other 23 factors and delirium were analyzed. Multivariate analysis of risk factors model, prospectively collected in 2016 02 to 2016 09 months 7 months (Study Group) 81 cases the clinical data and verified. Then paired 36 cases of delirium and patients without delirium, venous blood 2ml, 1H for NMR detection and analysis of the differences between the two groups of serum metabonomics. Results: 1. of all 304 patients, which are group 223 cases, posterior For group 81 cases occurred delirium, a total of 64 cases of patients, the incidence of 21.1%. group is multivariate analysis showed that history of hypertension (RR=4.367; P=0.020), hypoxemia (RR=3.382; P=0.018), the use of two benzodiazepines (RR=5.503; P=0.013), the depth of sedation (RR= 3.339; P=0.048), infection (RR=3.480; P=0.008) and mechanical ventilation (RR=3.547; P=0.037) were independent risk factors of ICU delirium risk prediction model. The accuracy of ICU of patients with delirium in the derivation group was 0.862, in the validation group for the 0.739. validation group is expected to ICU patients the incidence of delirium and the actual incidence rate had no statistical difference (P0.05).2. metabonomics detection without delirium patients with delirium were compared, isoleucine, leucine, valine, alanine, and acetoacetate peak was significantly increased, while the peak of citric acid was reduced significantly. Conclusion: 1. This study successfully constructed ICU Delirium prediction model 2. The metabolomics results showed that the amino acid metabolism, the three carboxylic acid cycle and the ketone body metabolism abnormality in ICU delirium patients

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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