心脏外科重症监护病房谵妄发生状况及相关危险因素分析

发布时间：2018-06-07 04:29

本文选题：ICU谵妄 + 心脏外科手术　；参考：《新乡医学院》2017年硕士论文

【摘要】：研究背景:谵妄是一种意识和注意障碍,伴有认知功能改变或者感知障碍,以病情反复波动为特征。进入ICU的患者面对诸如陌生的环境、死亡的恐惧、沟通障碍、限制家属陪护等情况时易出现一些退行性表现,最初被称为ICU综合征或ICU精神病,目前统一称为ICU谵妄。谵妄是目前公认的在重症监护病房引起发病率和病死率的一个重要因素。心脏外科监护病房(简称CSICU),入住的均为心脏手术患者。心脏外科手术操作复杂、时间长,对患者身心打击均较大,因此心脏手术病人更容易产生焦虑、恐惧,甚至思维紊乱等一系列精神障碍。谵妄的发生会使心脏病术后患者在ICU滞留时间延长、总住院时间也随之增加。由于当前对ICU谵妄,特别是心脏外科监护病房谵妄,缺乏明确的诊断标准和有效的治疗方式,所以人们致力于研究预防ICU谵妄的发生,尽早发现高危人群。研究目的:探讨心脏相关疾病手术后患者ICU谵妄发生的状况,明确影响心脏外科重症监护病房谵妄发生的相关危险因素并提出相关预防手段。方法:收集入住心脏外科重症监护病房的心脏外科术后患者200例,详细记录患者基本信息、手术方式、术中及术后ICU的治疗情况,通过应用CAM-ICU量表对心脏外科术后入住ICU的患者进行评估,同时对有关危险因素进行单因素和多因素的回归分析。结果:经过筛选符合纳入标准的200例患者进入本研究且顺利完成相关调查,调查人群中,64例患者发生了ICU谵妄,发生率达到了32%。单因素分析结果表明:年龄、家庭成员缺失、APACHE II评分、既往高血压病史、机械通气时间、手术方式和ICU滞留时间与ICU谵妄的发生密切相关;多因素回归分析结果表明:年龄、家庭成员缺失、APACHE II评分、机械通气时间和手术方式是影响ICU谵妄发生的独立风险因素。结论:心脏外科术后患者ICU谵妄的发生几率偏高,年龄越大、家庭成员缺失、APACHE II评分高、机械通气时间长以及手术方式的复杂化等独立风险因素都将增加ICU谵妄发生概率。
[Abstract]:Background: delirium is a disorder of consciousness and attention, accompanied by changes in cognitive function or cognitive impairment, characterized by repeated fluctuations in the condition. Patients entering ICU are prone to some degenerative manifestations such as unfamiliar environment, fear of death, communication barrier, restriction of family escort and so on. They are initially called ICU syndrome or ICU psychosis, and now they are commonly called ICU delirium. Delirium is currently recognized as an important factor in morbidity and mortality in intensive care units. Cardiac surgery ward (CSICU), admitted to all patients with cardiac surgery. The operation of cardiac surgery is complicated, long time, and has a great impact on the body and mind of the patients. Therefore, patients with cardiac surgery are more likely to produce a series of mental disorders, such as anxiety, fear, and even mental disorder. Delirium may lead to prolonged ICU retention and total hospital stay after heart surgery. Due to the lack of definite diagnostic criteria and effective treatment for ICU delirium, especially in cardiac surgery ward, people are devoting themselves to the study of preventing the occurrence of ICU delirium and finding high risk groups as soon as possible. Objective: to investigate the occurrence of ICU delirium in patients with cardiac related diseases after operation, to determine the risk factors affecting the occurrence of delirium in cardiac surgery intensive care unit (ICU) and to put forward relevant preventive measures. Methods: a total of 200 cardiac surgery patients admitted to cardiac surgery intensive care unit were collected. The basic information, operation methods, intraoperative and postoperative ICU treatment were recorded in detail. The patients who were admitted to ICU after cardiac surgery were evaluated by CAM-ICU scale, and the related risk factors were analyzed by univariate and multivariate regression analysis. Results: a total of 200 patients who met the inclusion criteria were selected to enter the study and successfully completed the investigation. 64 patients in the survey group developed delirium ICU, the incidence of which was 32. 2%. Univariate analysis showed that age, Apache II score, history of hypertension, duration of mechanical ventilation, operation mode and ICU retention time were closely related to the occurrence of ICU delirium. Absence of family members and Apache II score, mechanical ventilation time and surgical procedures were independent risk factors for the occurrence of ICU delirium. Conclusion: the higher the incidence of ICU delirium after cardiac surgery, the higher the age, the higher the Apache II score, the longer the duration of mechanical ventilation, the more complicated the operation mode, and other independent risk factors will increase the probability of occurrence of ICU delirium.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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