黄梦迪　王洁　葛杨玲　陈建萍

[摘要] 目的 对急危重症患者发生谵妄的危险因素进行分析，提出减少谵妄发生的优质治疗及护理方案。 方法 对我科2018年8月至2019年7月收治的238例危重症患者进行分析，参照美国精神病协会制定的《精神病的诊断和统计手册》第4版（DSM-IV）中的谵妄诊断标准，99例发生谵妄作为观察组，139例未发生谵妄的作为对照组。对两组可能发生的危险因素采用统计学方法处理。 结果 238例危重症患者，谵妄发生率为41.60%，发生率较高。单因素分析显示，两组患者在年龄、APACHE Ⅱ评分、机械通气时间、侵入性操作、使用镇静镇痛药、感染、住院时间比较，差异有统计学意义（P<0.05）;性别、BMI、合并症比较，差异无统计学意义（P>0.05）。Logistic回归分析显示，危重症患者发生谵妄的危险因素为年龄、APACHE Ⅱ评分、机械通气时间、侵入性操作、使用镇静镇痛药物、感染及住院时间的长短。 结论 危重症患者谵妄的发生率高，早期重视谵妄发生的危险因素，给予相应的方案及措施，可预防和减少谵妄的发生，促进危重症患者良好的预后。

[关键词] 危重癥;谵妄;危险因素;机械通气

[中图分类号] R459.7          [文献标识码] B          [文章编号] 1673-9701（2021）04-0169-04

Analysis on the risk factors of delirium in patients with critical illness

HUANG Mengdi   WANG Jie   GE Yangling   CHEN Jianping

Department of Critical Care Medicine， Taizhou Hospital of Zhejiang Province affliated to Wenzhou Medical University， Taizhou   317000， China

[Abstract] Objective To analyze the risk factors of delirium in patients with critical illness and put forward high-quality treatment and nursing schemes to reduce delirium. Methods A total of 238 cases of patients with critical illness admitted to our department from August 2018 to July 2019 were analyzed， and they were divided into the observation group （n=99， delirium occurred） and the control group（n=139， no delirium occurred） according to the diagnostic criteria of delirium in Diagnostic and Statistical Manual of Psychiatry（DSM-IV） formulated by American Psychiatric Association. The possible risk factors between the two groups were processed using statistical methods. Results In 238 cases of patients with critical illness， the incidence of delirium was 41.60%， which was relatively higher. From the univariate analysis， there were statistically significant differences between the two groups in age， Apache Ⅱ score， mechanical ventilation time， invasive operation， use of sedatives and analgesics， infection and hospitalization time（P<0.05）.There was no statistically significant difference in gender， BMI and complications（P>0.05）. According to the Logistic regression analysis， it was shown by the results that the risk factors of delirium in patients with critical illness were age， Apache Ⅱ score， mechanical ventilation time， invasive operation， use of sedatives and analyesics， infection and length of hospitalization time. Conclusion The incidence of delirium is high in patients with critical illness， so early attention should be paid to the risk factors of delirium，and corresponding schemes and measures should be given to prevent and reduce the occurrence of delirium and promote the good prognosis of patients with critical illness.

[Key words] Critical illness; Delirium; Risk factors; Mechanical ventilation

谵妄是患者的中枢神经系统出现异常，产生功能紊乱，这是一种不可逆的变化，对患者有严重的威胁，谵妄发生后患者延迟治疗1 d，死亡率会提高，治疗时间会延长，对患者的经济和生命都有着重要的影响[1]。重症监护室（ICU）是一个特殊的地方，其特有的治疗、病房环境及患者疾病等多种因素共同作用导致的一系列精神状态，而且也是谵妄发生率非常高的一个科室[2]。……