非创伤性蛛网膜下腔出血患者的多动性谵妄

Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage.

作者信息

Reimann Fabian, Rinner Thomas, Lindner Anna, Kofler Mario, Ianosi Bogdan-Andrei, Schiefecker Alois Josef, Beer Ronny, Schmutzhard Erich, Pfausler Bettina, Helbok Raimund, Rass Verena

机构信息

Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.

Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Institute of Medical Informatics, UMIT: University for Health Sciences, Biomedical Informatics and Mechatronics, Medical Informatics and Technology, Eduard Wallnoefer-Zentrum 1, 6060 Hall i.T, Austria.

出版信息

J Crit Care. 2021 Aug;64:45-52. doi: 10.1016/j.jcrc.2021.02.010. Epub 2021 Mar 8.

DOI:10.1016/j.jcrc.2021.02.010

PMID:33794466

Abstract

PURPOSE

Hyperactive delirium is common after subarachnoid hemorrhage (SAH). We aimed to identify risk factors for delirium and to evaluate its impact on outcome.

METHODS

We collected daily Richmond Agitation Sedation Scale (RASS) and Intensive Care Delirium Screening Checklist (ICDSC) scores in 276 SAH patients. Hyperactive delirium was defined as ICDSC ≥4 when RASS was >0. We investigated risk factors for delirium and its association with 3-month functional outcome using generalized linear models.

RESULTS

Patients were 56 (IQR 47-67) years old and had a Hunt&Hess (H&H) grade of 3 (IQR 1-5). Sixty-five patients (24%) developed hyperactive delirium 6 (IQR 3-16) days after SAH. In multivariable analysis, mechanical ventilation>48 h (adjOR = 4.46; 95%-CI = 1.89-10.56; p = 0.001), the detection of an aneurysm (adjOR = 4.38; 95%-CI = 1.48-12.97; p = 0.008), a lower H&H grade (adjOR = 0.63; 95%-CI = 0.48-0.83; p = 0.001) and a pre-treated psychiatric disorder (adjOR = 3.17; 95%-CI = 1.14-8.83; p = 0.027) were associated with the development of delirium. Overall, delirium was not associated with worse outcome (p = 0.119). Interestingly, patients with delirium more often had a modified Rankin Scale Score (mRS) of 1-3 (77%) compared to an mRS of 0 (14%) or 4-6 (9%).

CONCLUSION

Our data indicate that hyperactive delirium is common after SAH patients and requires a certain degree of brain connectivity based ono the highest prevalence found in SAH patients with intermediate outcomes.

摘要

目的

蛛网膜下腔出血（SAH）后躁动谵妄很常见。我们旨在确定谵妄的危险因素并评估其对预后的影响。

方法

我们收集了276例SAH患者的每日里士满躁动镇静量表（RASS）和重症监护谵妄筛查清单（ICDSC）评分。当RASS>0时，躁动谵妄定义为ICDSC≥4。我们使用广义线性模型研究了谵妄的危险因素及其与3个月功能预后的关联。

结果

患者年龄为56岁（四分位间距47 - 67岁），Hunt&Hess（H&H）分级为3级（四分位间距1 - 5级）。65例患者（24%）在SAH后6天（四分位间距3 - 16天）出现躁动谵妄。在多变量分析中，机械通气>48小时（调整后比值比 = 4.46；95%置信区间 = 1.89 - 10.56；p = 0.001）、动脉瘤的发现（调整后比值比 = 4.38；95%置信区间 = 1.48 - 12.97；p = 0.008）、较低的H&H分级（调整后比值比 = 0.63；95%置信区间 = 0.48 - 0.83；p = 0.001）和既往治疗过的精神疾病（调整后比值比 = 3.17；95%置信区间 = 1.14 - 8.83；p = 0.027）与谵妄的发生相关。总体而言，谵妄与较差的预后无关（p = 0.119）。有趣的是，与改良Rankin量表评分为0（14%）或4 - 6（9%）相比，谵妄患者更常出现改良Rankin量表评分为1 - 3（77%）。