重症监护病房老年病人脓毒症相关谵妄的危险因素分析

doi:10.3969/j.issn.1003-9198.2023.07.014

摘要/Abstract

摘要： 目的探讨ICU老年病人脓毒症相关谵妄(SAD)的危险因素,为SAD临床诊治和预防提供参考。方法回顾性选择2017年2月至2022年2月我院收治的352例老年脓毒症病人,根据混淆评定方法-ICU-7(CAM-ICU-7)评分将病人分为SAD组(158例)和非SAD组(194例)。收集2组临床资料和实验室指标,采用多因素Logistic回归分析SAD的影响因素。结果 SAD组年龄大于非SAD组,序贯器官衰竭评估(SOFA)评分、APACHE Ⅱ评分,脓毒症休克、机械通气、使用镇静剂、合并高血糖、合并高碳酸血症比例,血清IL-6、TNF-α、CRP和 S-100β蛋白水平高于非SAD组,差异均有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示,高龄、合并高血糖、合并高碳酸血症、使用镇静剂,高IL-6、S-100β水平,高SOFA、APACHE Ⅱ评分是SAD发病的危险因素。结论 ICU老年病人发生SAD受很多因素的影响,积极评估这些指标有助于早期识别谵妄。

关键词: 重症监护病房, 谵妄, 脓毒症, 高血糖, 高碳酸血症, 神经炎症

Abstract: Objective To investigate the risk factors of sepsis-associated delirium(SAD) in intensive care unit(ICU) in the elderly with sepsis, and to provide reference for clinical diagnosis, treatment and prevention of SAD. Methods A total of 352 elderly patients with sepsis admitted to our hospital from February 2017 to February 2022 were retrospectively enrolled and divided into the SAD group(158 cases) and the non-SAD group(194 cases) according to the confusion-assessment method -ICU-7(CAM-ICU-7) score. The clinical data and laboratory data were collected, and multiple Logistic regression was used to analyze the influencing factors of SAD. Results The age of the SAD group was higher than that of the non-SAD group(P<0.05). The scores of Sequential Organ Failure Assessment (SOFA) and Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ), the proportion of septic shock, mechanical ventilation, sedative use, hyperglycemia, hypercapnia, and the serum levels of interleukin(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) and S-100β protein in the SAD group were higher than those in the non-SAD group(P<0.05). Multivariate Logistic regression analysis showed that age, hyperglycemia, hypercapnia, use of sedative, IL-6, S-100β, SOFA score and APACHE Ⅱ score were risk factors for SAD(P<0.05). Conclusions The incidence of SAD in the elderly patients in ICU is influenced by lots of factors. Positively assessing the parameters is helpful to monitor the incidence of SAD.

Key words: intensive care unit, delirium, sepsis, hyperglycemia, hypercapnia, nerve inflammation

中图分类号:

赵艳, 谢志娟, 洪莎, 李琴繁. 重症监护病房老年病人脓毒症相关谵妄的危险因素分析[J]. 实用老年医学, 2023, 37(7): 705-708.

ZHAO Yan, XIE Zhi-juan, HONG Sha, LI Qin-fan. Analysis of risk factors for delirium in elderly patients with sepsis in intensive care unit[J]. Practical Geriatrics, 2023, 37(7): 705-708.

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