重症监护室患者谵妄发生情况及其影响因素分析

摘要

Objective To investigate the delirium occurrence and influence factors of ICU patients. Methods Form March 2009 to February 2013, the data of 503 patients treated in ICU, the First Affiliated Hospital of Kunming Medical University were selected and divided into the delirium group (85 cases) and the control group (418 cases) according to whether delirium or not in ICU. The clinical data of two groups were compared by single factor analysis data and Lo-gistic multifactor regression analysis to find out the delirium occurrence and influence factors of ICU patients. Results 16.90% (85/503) ICU patients occured delirium. There were statistically significant differences among age, diabetes, low blood pressure and cardiac shock, ischemia, electrolyte disorder, sleep disorder, using imidazole valium, infection, ejection fraction < 40% and the mechanical ventilation situation (P< 0.05). The low blood pressure and cardiac shock (β=1.830, OR = 6.290), oxygen (β=1.778, OR = 5.918), electrolyte disorder (β=1.462, OR = 1.462), sleep disorders (β=1.475, OR =1.475), using imidazole valium (β=1.746, OR =1.746), infection (β=1.759, OR =1.759), and mechan-ical ventilation (β=1.822, OR =1.822) were independent risk factors for delirium in ICU (P< 0.05). Conclusion Low blood pressure, cardiac shock, ischemia, electrolyte disorder, sleep disorder, using imidazole stability, infection, me-chanical ventilation are independently risk factors of delirium patients in ICU, timely targete measures should be given to reduce the risk of the occurrence of delirium for patients with the clinical features,.%目的：探讨分析重症监护室患者谵妄发生情况及其影响因素。方法选择2009年3月~2013年2月于昆明医科大学第一附属医院重症监护室收治的503例患者的临床资料，根据患者在重症监护室期间是否发生谵妄将所有患者分为谵妄组(85例)和对照组(418例)，比较两组患者的临床资料，采用单因素分析，Logistic多因素回归分析重症监护室患者谵妄发生情况及其影响因素。结果503例患者中16.90%(85/503)的患者发生谵妄，谵妄组与对照组在年龄、糖尿病、低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、射血分数<40%、机械通气情况的比较差异有统计学意义(P<0.05)。低血压或心源性休克(β=1.830，OR =6.290)、缺氧(β=1.778，OR =5.918)、电解质紊乱(β=1.462，OR =4.315)、睡眠障碍(β=1.475，OR =4.371)、使用咪唑安定(β=1.746，OR =5.732)、感染(β=1.759，OR =5.807)、机械通气(β=1.822，OR =6.184)是重症监护室患者发生谵妄的独立危险因素。结论低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、机械通气是重症监护室患者发生谵妄的独立危险因素，对于合并有上述临床特征的患者，应及时实施针对性的措施以降低患者发生谵妄的风险。