谵妄对泰国多中心外科重症监护病房临床结局的影响：一项前瞻性队列研究。

The Impact of Delirium on Clinical Outcomes in Multi-Center Thai Surgical Intensive Care Units: A Prospective Cohort Study.

作者信息

Pipanmekaporn Tanyong, Chittawatanarat Kaweesak, Chaiwat Onuma, Thawitsri Thammasak, Wacharasint Petch, Kongsayreepong Suneerat

出版信息

J Med Assoc Thai. 2016 Sep;99 Suppl 6:S226-S232.

PMID:29906384

Abstract

OBJECTIVE

Delirium in intensive care units (ICU) increases risks in prolonged mechanical ventilation, hospitalization, and mortality rate. The purpose of this study is to determine if delirium in the surgical intensive care units (SICU) is an independent predictor of clinical outcomes during hospitalization.

MATERIAL AND METHOD

A multi-center, prospective cohort study was conducted between April 2011 and January 2013. All patients who were admitted to nine university-based SICU were enrolled. Delirium was diagnosed by using the Intensive Care Delirium Screening Checklists. The clinical outcomes of study included length of mechanical ventilation, length of hospital stay, ICU and 28 day mortality. Cox proportional hazard regression model was used to assess the effects of delirium on ICU and 28 day mortality.

RESULTS

A total of 4,652 patients were included. One hundred and sixty-three patients were diagnosed delirium (3.5%, 163 of 4,652). Patients who experienced delirium during ICU admission were significantly older (65.0+15.8 years versus 61.6+17.3 years, p = 0.013), had higher American Society of Anesthesiologists physical status (24.3% versus 12.2%, p<0.001), higher Acute Physiology and Chronic Health Evaluation II score (16 (12-23) versus 10 (7-15), p<0.001), and higher Sequential Organ Failure Assessment score (5 (2-8) versus 2 (1-5), p<0.001) compared to non-delirium. Delirious patients also had higher ventilator days (7 (4-17) versus 2 (1-4), p<0.001, longer length of hospital stay (22 (14-34) versus 15 (9-26), p<0.001) and higher ICU mortality (24% versus 9%, p<0.001), and 28-day mortality (28% versus 13%, p<0.001). Patients who developed delirium in the intensive care unit were associated with increased 28-day mortality (adjusted HR = 2.47, 95% CI: 1.13-5.41, p = 0.023).

CONCLUSION

Delirium in an ICU was a major predictor of hospital mortality after adjusted for relevant covariates. Routine monitoring of delirium, early detection, and implementation of preventive strategy are recommended.

摘要

目的

重症监护病房（ICU）中的谵妄会增加延长机械通气时间、住院时间和死亡率的风险。本研究的目的是确定外科重症监护病房（SICU）中的谵妄是否是住院期间临床结局的独立预测因素。

材料与方法

在2011年4月至2013年1月期间进行了一项多中心前瞻性队列研究。纳入了所有入住九所大学附属医院SICU的患者。使用重症监护谵妄筛查清单诊断谵妄。研究的临床结局包括机械通气时间、住院时间、ICU死亡率和28天死亡率。采用Cox比例风险回归模型评估谵妄对ICU死亡率和28天死亡率的影响。

结果

共纳入4652例患者。163例患者被诊断为谵妄（4652例中的3.5%，即163例）。入住ICU期间发生谵妄的患者明显年龄更大（65.0±15.8岁对61.6±17.3岁，p = 0.013），美国麻醉医师协会身体状况分级更高（24.3%对12.2%，p<0.001），急性生理与慢性健康状况评估II评分更高（16（12 - 23）对10（7 - 15），p<0.001），序贯器官衰竭评估评分更高（5（2 - 8）对2（1 - 5），p<0.001）。与未发生谵妄的患者相比，发生谵妄的患者机械通气天数也更多（7（4 - 17）天对2（1 - 4）天，p<0.001），住院时间更长（22（14 - 34）天对15（9 - 26）天，p<0.001），ICU死亡率更高（24%对9%，p<0.001），28天死亡率更高（28%对13%，p<0.001）。在重症监护病房发生谵妄的患者与28天死亡率增加相关（校正风险比 = 2.47，95%置信区间：1.13 - 5.41，p = 0.023）。