本文關(guān)鍵詞： 譫妄 發(fā)生率 危險(xiǎn)因素 代謝組學(xué)　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討ICU譫妄患者的危險(xiǎn)因素及相關(guān)差異標(biāo)志代謝物。方法回顧分析皖南醫(yī)學(xué)院弋磯山醫(yī)院重癥監(jiān)護(hù)病房(ICU)2014年09月至2016年01月16個(gè)月(推導(dǎo)組)住院超過24小時(shí)的223例患者。每天采用CAM-ICU法對患者進(jìn)行兩次評估,并將患者分為譫妄組與非譫妄組。采用單因素和多因素logistic回歸對高血壓病史等23個(gè)因素與譫妄發(fā)生之間的關(guān)系進(jìn)行分析。多因素分析得出危險(xiǎn)因素模型后,前瞻性收集2016年02月至2016年09月7個(gè)月(驗(yàn)證組)81例患者的臨床資料并進(jìn)行驗(yàn)證。再配對選擇36例譫妄與無譫妄患者,取靜脈血2ml,行1H NMR檢測分析兩組血清代謝組學(xué)的差異。結(jié)果:1.全部304例患者,其中推導(dǎo)組223例,驗(yàn)證組81例,共64例患者發(fā)生了譫妄,發(fā)生率為21.1%。推導(dǎo)組多因素分析發(fā)現(xiàn)有高血壓病史(RR=4.367;P=0.020)、低氧血癥(RR=3.382;P=0.018)、苯二氮卓類藥物的使用(RR=5.503;P=0.013)、深度鎮(zhèn)靜(RR=3.339;P=0.048)、感染(RR=3.480;P=0.008)和機(jī)械通氣(RR=3.547;P=0.037)是ICU患者發(fā)生譫妄的獨(dú)立危險(xiǎn)因素。危險(xiǎn)模型預(yù)測ICU患者發(fā)生譫妄的準(zhǔn)確性在推導(dǎo)組為0.862,在驗(yàn)證組為0.739。驗(yàn)證組的預(yù)計(jì)ICU患者譫妄發(fā)生率與實(shí)際發(fā)生率相比無統(tǒng)計(jì)學(xué)差異(P0.05)。2.代謝組學(xué)檢測發(fā)現(xiàn)無譫妄組患者與譫妄組患者相比,異亮氨酸、亮氨酸、纈氨酸、丙氨酸、和乙酰乙酸的峰值明顯增高,而檸檬酸的峰值則明顯降低。結(jié)論:1、本研究成功構(gòu)建了ICU譫妄預(yù)測模型2、代謝組學(xué)研究結(jié)果顯示ICU譫妄患者氨基酸代謝、三羧酸循環(huán)和酮體代謝異常
[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

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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本文編號：1497447