本文關(guān)鍵詞：ICU譫妄持續(xù)時(shí)間及影響因素的研究　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： ICU譫妄 持續(xù)時(shí)間 抗精神病藥物 缺氧 譫妄類(lèi)型

【摘要】：研究背景:ICU譫妄是由于ICU病人經(jīng)歷的一系列打擊所致的一種中樞神經(jīng)系統(tǒng)的急性功能障礙,有關(guān)ICU譫妄發(fā)生的危險(xiǎn)因素,已有研究對(duì)其進(jìn)行了探索并進(jìn)行了相應(yīng)預(yù)防措施的實(shí)施,然而其發(fā)生率仍高達(dá)35%-80%。ICU譫妄發(fā)生之后,危害度極大,嚴(yán)重影響了患者預(yù)后,給患者帶來(lái)一系列不良的近期影響及遠(yuǎn)期影響。ICU譫妄持續(xù)時(shí)間與危害度正相關(guān),而國(guó)外僅有少量研究描述譫妄持續(xù)時(shí)間,但并未對(duì)影響ICU譫妄持續(xù)時(shí)間的因素進(jìn)行探討,國(guó)內(nèi)亦沒(méi)有相關(guān)研究,因此ICU譫妄發(fā)生后,本研究對(duì)其持續(xù)時(shí)間進(jìn)行描述,并對(duì)影響ICU譫妄持續(xù)時(shí)間因素進(jìn)行探究。研究目的:(1)描述ICU譫妄患者的譫妄持續(xù)時(shí)間;(2)探究影響ICU譫妄患者譫妄持續(xù)時(shí)間的因素。研究方法:選取北京協(xié)和醫(yī)院重癥醫(yī)學(xué)科2016年4月-2016年12月期間發(fā)生ICU譫妄的患者作為研究對(duì)象。于患者首次發(fā)生譫妄后,收集患者一般資料以及機(jī)械通氣、鎮(zhèn)靜鎮(zhèn)痛藥物使用、抗精神病藥物使用、缺氧、感染、內(nèi)環(huán)境、譫妄類(lèi)型等臨床資料,記錄對(duì)患者所采取的譫妄管理措施,至患者譫妄評(píng)估為陰性或患者轉(zhuǎn)出ICU。通過(guò)Kaplan-Meier單因素分析和Cox多因素分析探討ICU譫妄持續(xù)時(shí)間的影響因素。結(jié)果:(1)從2016年4月至2016年12月,共對(duì)870名轉(zhuǎn)入ICU的患者進(jìn)行譫妄評(píng)估,篩查出譫妄患者77例,ICU譫妄發(fā)生率為8.9%。研究對(duì)象年齡范圍為32-83歲,平均年齡61.81±12.84歲。ICU譫妄持續(xù)時(shí)間平均為(5.06±4.59)天,中位持續(xù)時(shí)間為4天。ICU譫妄總體評(píng)分呈平穩(wěn)趨勢(shì),在5天之內(nèi)波動(dòng)于4.06至4.46之間。(2)單因素分析顯示,年齡、APACHEⅡ評(píng)分、譫妄類(lèi)型A(鎮(zhèn)靜相關(guān)譫妄或持續(xù)性譫妄)、譫妄類(lèi)型B(安靜型譫妄、躁動(dòng)型譫妄或混合型譫妄)、機(jī)械通氣時(shí)間、內(nèi)環(huán)境紊亂時(shí)間、缺氧時(shí)間、感染時(shí)間、抗精神病藥物使用時(shí)間以及ABCDEF集束策略的實(shí)施數(shù)目等因素組間整體比較有顯著差異。(3)Cox回歸分析顯示,APACHEⅡ評(píng)分、譫妄類(lèi)型A、缺氧時(shí)間以及抗精神病藥物使用時(shí)間(χ2=4.670,P=0.031;x2=5.801,P=0.016;χ2=14.438,P0.001;χ2=13.360,P0.001)為 ICU譫妄持續(xù)時(shí)間的影響因素。結(jié)論:ICU譫妄發(fā)生率為8.9%,平均持續(xù)時(shí)間為(5.06±4.09)天,持續(xù)時(shí)間與APACHE Ⅱ評(píng)分、譫妄類(lèi)型A、缺氧時(shí)間以及抗精神病藥物使用時(shí)間相關(guān)。醫(yī)護(hù)人員應(yīng)對(duì)病情嚴(yán)重程度高、持續(xù)性譫妄、存在缺氧的患者加強(qiáng)譫妄管理,并慎用抗精神病藥物,以盡可能降低譫妄持續(xù)時(shí)間,改善患者預(yù)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 鹵12.84 years. The average duration of delirium in ICU was 5.06 鹵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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