老年 COPD 合并呼吸衰竭机械通气患者谵妄：前瞻性队列研究。
Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study.
机构信息
Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China.
出版信息
BMC Pulm Med. 2022 Jul 9;22(1):266. doi: 10.1186/s12890-022-02052-5.
BACKGROUND
COPD combined with respiratory failure is very common in intensive care unit (ICU). We aimed to evaluate the current status and influencing factors of delirium in elderly COPD patients with undergoing mechanical ventilation.
METHODS
Patients with COPD combined with respiratory failure and mechanically ventilated who were admitted to the ICU of our hospital were selected. The characteristics of included patients were assessed. Pearson correlation analysis was performed to evaluate the characteristics of patients and delirium. Logistic regression analysis was conducted to identify the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation.
RESULTS
A total of 237 COPD combined with respiratory failure patients were included, the incidence of delirium was 21.94%. Pearson correlation analysis indicated that age (r = 0.784), BMI (r = 0.709), hypertension (r = 0.696), APACHE II score (r = 0.801), CPOT (r = 0.513), sedation(r = 0.626) and PaO (r = 0.611) were all correlated with the occurrence of delirium (all p < 0.05). Logistic regression analysis indicated that age ≥ 75y (OR 3.112, 95% CI 2.144-4.602), BMI ≤ 19 kg/m (OR 2.742, 95% CI 1.801-3.355), hypertension(OR 1.909, 95% CI 1.415-2.421), APACHE II score ≥ 15 (OR 2.087, 95% CI 1.724-2.615), CPOT ≥ 5 (OR 1.778, 95% CI 1.206-2.641), sedation(OR 3.147, 95% CI 2.714-3.758), PaO ≤ 75 mmHg(OR 2.196, 95%CI 1.875-3.088) were the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation (all p < 0.05).
CONCLUSIONS
Delirium is common in patients with COPD and respiratory failure undergoing mechanical ventilation, and there are many related influencing factors. Medical staff should pay more attention to patients with risk factors and take intervention measures as soon as possible to reduce the incidence of delirium.
背景
慢性阻塞性肺疾病（COPD）合并呼吸衰竭在重症监护病房（ICU）中非常常见。本研究旨在评估行机械通气的老年 COPD 合并呼吸衰竭患者发生谵妄的现状及其影响因素。
方法
选取我院 ICU 收治的 COPD 合并呼吸衰竭且行机械通气的患者，评估纳入患者的一般特征。采用 Pearson 相关分析评估患者特征与谵妄的相关性。采用 Logistic 回归分析确定老年 COPD 合并呼吸衰竭行机械通气患者发生谵妄的危险因素。
结果
共纳入 237 例 COPD 合并呼吸衰竭患者，谵妄发生率为 21.94%。Pearson 相关分析表明，年龄（r=0.784）、BMI（r=0.709）、高血压（r=0.696）、APACHE II 评分（r=0.801）、CPOT（r=0.513）、镇静（r=0.626）和 PaO（r=0.611）均与谵妄的发生相关（均 P<0.05）。Logistic 回归分析表明，年龄≥75 岁（OR=3.112，95%CI：2.1444.602）、BMI≤19 kg/m（OR=2.742，95%CI：1.8013.355）、高血压（OR=1.909，95%CI：1.4152.421）、APACHE II 评分≥15（OR=2.087，95%CI：1.7242.615）、CPOT≥5（OR=1.778，95%CI：1.2062.641）、镇静（OR=3.147，95%CI：2.7143.758）、PaO≤75 mmHg（OR=2.196，95%CI：1.875~3.088）是老年 COPD 合并呼吸衰竭行机械通气患者发生谵妄的危险因素（均 P<0.05）。
结论
老年 COPD 合并呼吸衰竭患者行机械通气时谵妄较为常见，且存在较多相关影响因素。医护人员应多关注有危险因素的患者，并尽早采取干预措施，降低谵妄的发生率。
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