Svenningsen Helle, Tønnesen Else
Arhus Universitetshospital, Arhus Sygehus, Anastesiologisk Afdeling, Denmark.
Ugeskr Laeger. 2009 Nov 30;171(49):3600-4.
Intensive care unit (ICU)-delirium is defined by an acute, fluctuating course. Hallucinations and anxiety are frequent. This patient group experiences increased morbidity and mortality. The incidence of ICU-delirium is reported to range from 16% to 87% in international studies, but until now the incidence in Denmark has remained unknown. Many studies focus on the risk in elderly patients. The aim of this study was to elucidate the incidence of ICU-delirium in Denmark and to describe relations to medication and age.
At three ICUs, a total of 139 adult patients were screened for delirium by the Confusion Assessment Method for the ICU (CAM-ICU) from 48 hours after admission and until they were transferred to another ward or died. The CAM-ICU takes into account the sedation level of the patient and is applicable even if patients are in a respirator.
A total of 41 patients (29.5%) had at least one positive score for delirium, 61 (43.9%) never had a positive score and 37 (26.6%) were too sedated throughout their stay at the ICU to be scored. Thus, the incidence for ICU-delirium was 40.2% among patients eligible for scoring by the CAM-ICU. Lightly sedated patients (with or without medication) had a 10-fold increased risk of ICU-delirium. Age was not associated with any difference in incidence. Patients were mostly unsedated when scored to have delirium; no sedation medication significantly increased ICU-delirium. Fentanyl used as analgesic showed an increased relative risk of 4.79.
ICU-delirium is common and occurred in all age groups in the present study.
重症监护病房（ICU）谵妄的定义为病程急性且波动。幻觉和焦虑较为常见。该患者群体的发病率和死亡率有所增加。国际研究报告称，ICU谵妄的发病率在16%至87%之间，但迄今为止丹麦的发病率仍不清楚。许多研究关注老年患者的风险。本研究的目的是阐明丹麦ICU谵妄的发病率，并描述其与药物治疗和年龄的关系。
在三个ICU中，对139名成年患者从入院后48小时起直至转至另一病房或死亡，采用ICU意识模糊评估法（CAM-ICU）进行谵妄筛查。CAM-ICU考虑了患者的镇静水平，即使患者使用呼吸机也适用。
共有41名患者（29.5%）至少有一次谵妄阳性评分，61名（43.9%）从未有过阳性评分，37名（26.6%）在ICU住院期间一直处于深度镇静状态而无法进行评分。因此，在符合CAM-ICU评分条件的患者中，ICU谵妄的发病率为40.2%。轻度镇静的患者（无论是否用药）发生ICU谵妄的风险增加了10倍。年龄与发病率的差异无关。谵妄评分时患者大多未使用镇静药物；没有哪种镇静药物会显著增加ICU谵妄的发生率。用作镇痛药的芬太尼显示相对风险增加了4.79。
ICU谵妄很常见，在本研究的所有年龄组中均有发生。
