本文選題：ICU譫妄 + 心臟外科手術(shù)　； 參考：《新鄉(xiāng)醫(yī)學院》2017年碩士論文

【摘要】：研究背景:譫妄是一種意識和注意障礙,伴有認知功能改變或者感知障礙,以病情反復(fù)波動為特征。進入ICU的患者面對諸如陌生的環(huán)境、死亡的恐懼、溝通障礙、限制家屬陪護等情況時易出現(xiàn)一些退行性表現(xiàn),最初被稱為ICU綜合征或ICU精神病,目前統(tǒng)一稱為ICU譫妄。譫妄是目前公認的在重癥監(jiān)護病房引起發(fā)病率和病死率的一個重要因素。心臟外科監(jiān)護病房(簡稱CSICU),入住的均為心臟手術(shù)患者。心臟外科手術(shù)操作復(fù)雜、時間長,對患者身心打擊均較大,因此心臟手術(shù)病人更容易產(chǎn)生焦慮、恐懼,甚至思維紊亂等一系列精神障礙。譫妄的發(fā)生會使心臟病術(shù)后患者在ICU滯留時間延長、總住院時間也隨之增加。由于當前對ICU譫妄,特別是心臟外科監(jiān)護病房譫妄,缺乏明確的診斷標準和有效的治療方式,所以人們致力于研究預(yù)防ICU譫妄的發(fā)生,盡早發(fā)現(xiàn)高危人群。研究目的:探討心臟相關(guān)疾病手術(shù)后患者ICU譫妄發(fā)生的狀況,明確影響心臟外科重癥監(jiān)護病房譫妄發(fā)生的相關(guān)危險因素并提出相關(guān)預(yù)防手段。方法:收集入住心臟外科重癥監(jiān)護病房的心臟外科術(shù)后患者200例,詳細記錄患者基本信息、手術(shù)方式、術(shù)中及術(shù)后ICU的治療情況,通過應(yīng)用CAM-ICU量表對心臟外科術(shù)后入住ICU的患者進行評估,同時對有關(guān)危險因素進行單因素和多因素的回歸分析。結(jié)果:經(jīng)過篩選符合納入標準的200例患者進入本研究且順利完成相關(guān)調(diào)查,調(diào)查人群中,64例患者發(fā)生了ICU譫妄,發(fā)生率達到了32%。單因素分析結(jié)果表明:年齡、家庭成員缺失、APACHE II評分、既往高血壓病史、機械通氣時間、手術(shù)方式和ICU滯留時間與ICU譫妄的發(fā)生密切相關(guān);多因素回歸分析結(jié)果表明:年齡、家庭成員缺失、APACHE II評分、機械通氣時間和手術(shù)方式是影響ICU譫妄發(fā)生的獨立風險因素。結(jié)論:心臟外科術(shù)后患者ICU譫妄的發(fā)生幾率偏高,年齡越大、家庭成員缺失、APACHE II評分高、機械通氣時間長以及手術(shù)方式的復(fù)雜化等獨立風險因素都將增加ICU譫妄發(fā)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.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2

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本文編號：1989777