ICU病人活动减少型谵妄发生现状及影响因素分析

    Analysis of the current situation and influencing factors of hypoactive delirium in ICU patients

    • 摘要: 目的: 探讨ICU病人活动减少型谵妄的影响因素并建立预测模型,为临床护士正确识别活动减少型谵妄提供参考依据。方法: 于2023年3月至2024年7月选取在安徽医科大学第一附属医院重症医学科入住的病人为研究对象,采用ICU意识模糊评估法和Richmond躁动-镇静评分对病人进行谵妄评定,使用一般资料调查表、急性生理与慢性健康评分Ⅱ(APACHE Ⅱ评分)、Barthel指数(BI)对活动减少型谵妄病人影响因素进行分析,通过ROC曲线验证模型拟合优度及预测效果。结果: 共纳入197例研究对象,其中99例病人发生谵妄,谵妄发生率为50.25%,其中活动减少型65例(65.66%),活动增多型11例(11.11%),混合型23例(23.23%)。发生活动减少型谵妄病人与未发生谵妄病人在年龄、合并慢性病种类、睡眠紊乱、低钠血症、脓毒血症、机械通气、急诊手术、约束、导管、尿素氮、二氧化碳分压、C反应蛋白、APACHEⅡ评分、BI分值上比较,差异均有统计学意义(P<0.05~P<0.01)。logistic 回归分析结果显示,低钠血症、机械通气、急诊手术、C反应蛋白、APACHEⅡ评分、BI得分是ICU病人活动减少型谵妄发生的独立预测因子(P<0.05~P<0.01)。通过ROC曲线对模型拟合度进行评价,曲线下面积为0.972,95%CI为0.948~0.996,灵敏度为98.5%,特异度为88.8%,Hosmer-Lemeshow检验结果显示,模型拟合度较高(P=0.81)。结论: ICU病人谵妄发生率较高,主要以活动减少型谵妄为主,活动减少型谵妄预测模型提示要关注低钠血症、机械通气、有急诊手术史、C反应蛋白升高、APACHEⅡ评分较高以及日常生活能力较低的病人。预测模型可以对病人进行早期活动减少型谵妄的筛查。

       

      Abstract: Objective: To explore the influencing factors of hypoactive delirium in ICU patients and establish a prediction model,providing a reference basis for clinical nurses to correctly identify hypoactive delirium. Methods: From March 2023 to July 2024,patients admitted to the department of critical care medicine of The First Affiliated Hospital of Anhui Medical University were selected as the research subjects.The ICU confusion assessment method and the Richmond resting-sedation score were used to evaluate delirium in the patients.The influencing factors of patients with hypoactive delirium were analyzed using the general information questionnaire,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ score),and Barthel index (BI),and the goodness of fit and predictive effect of the model were verified through the ROC curve. Results: A total of 197 research subjects were included.Among them,99 patients developed delirium,with an incidence rate of 50.25%.Among them,65 cases (65.66%) were the hypoactive type,11 cases (11.11%) were the increased activity type,and 23 cases (23.23%) were the mixed type.The patients with hypoactive delirium and those without delirium were compared in terms of age,types of concurrent chronic diseases,sleep disorders,hyponatremia,sepsis,mechanical ventilation,emergency surgery,restraint,catheterization,urea nitrogen,PaCO2,C-reactive protein,APACHEⅡscore,BI score.The differences were all statistically significant (P<0.05 to P<0.01).The results of logistic regression analysis showed that hyponatremia,mechanical ventilation,emergency surgery,C-reactive protein,APACHE Ⅱ score,and BI score were independent predictors of hypoactive delirium in ICU patients (P<0.05 to P<0.01).The model fit was evaluated by the ROC curve.The area under the curve was 0.972,95%CI was 0.948-0.996,the sensitivity was 98.5%,the specificity was 88.8%.The Hosmer-Lemeshow test results showed that the model fit was relatively high (P=0.81). Conclusions: The incidence of delirium in ICU patients is relatively high,mainly in the form of hypoactive delirium.The prediction model of hypoactive delirium suggests that attention should be paid to patients with hyponatremia,mechanical ventilation,a history of emergency surgery,elevated C-reactive protein,a higher APACHE Ⅱ score,and a lower ability of daily living.The prediction model can screen patients for early hypoactive delirium.

       

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