He Dehua, Zhang Qianfu, Zhou Xiaoqian, Zhong Jianmin, Lin Xianwen, Shen Feng, Liu Ying, Tang Yan, Wang Difen, Liu Xu
Department of Critical Care Medicine, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China. Corresponding author: Liu Xu, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jun;35(6):638-642. doi: 10.3760/cma.j.cn121430-20220913-00832.
To investigate the prevalence, risk factors, duration and outcome of delirium in intensive care unit (ICU) patients.
A prospective observational study was conducted for critically ill patients admitted to the department of critical care medicine, the Affiliated Hospital of Guizhou Medical University from September to November 2021. Delirium assessments were performed twice daily using the Richmond agitation-sedation scale (RASS) and confusion assessment method of ICU (CAM-ICU) for patients who met the inclusions and exclusion criteria. Patient's age, gender, body mass index (BMI), underlying disease, acute physiologic assessment and chronic health evaluation (APACHE) at ICU admission, sequential organ failure assessment (SOFA) at ICU admission, oxygenation index (PaO/FiO), diagnosis, type of delirium, duration of delirium, outcome, etc. were recorded. Patients were divided into delirium and non-delirium groups according to whether delirium occurred during the study period. The clinical characteristics of the patients in the two groups were compared, and risk factors for the development of delirium were screened using univariate analysis and multivariate Logistic regression analysis.
A total of 347 ICU patients were included, and delirium occurred in 57.6% (200/347) patients. The most common type was hypoactive delirium (73.0% of the total). Univariate analysis showed statistically significant differences in age, APACHE score and SOFA score at ICU admission, history of smoking, hypertension, history of cerebral infarction, immunosuppression, neurological disease, sepsis, shock, glucose (Glu), PaO/FiO at ICU admission, length of ICU stay, and duration of mechanical ventilation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.045, 95% confidence interval (95%CI) was 1.027-1.063, P < 0.001], APACHE score at ICU admission (OR = 1.049, 95%CI was 1.008-1.091, P = 0.018), neurological disease (OR = 5.275, 95%CI was 1.825-15.248, P = 0.002), sepsis (OR = 1.941, 95%CI was 1.117-3.374, P = 0.019), and duration of mechanical ventilation (OR = 1.005, 95%CI was 1.001-1.009, P = 0.012) were all independent risk factors for the development of delirium in ICU patients. The median duration of delirium in ICU patients was 2 (1, 3) days. Delirium was still present in 52% patients when they discharged from the ICU.
The prevalence of delirium in ICU patients is over 50%, with hypoactive delirium being the most common. Age, APACHE score at ICU admission, neurological disease, sepsis and duration of mechanical ventilation were all independent risk factors for the development of delirium in ICU patients. More than half of patients with delirium were still delirious when they discharged from the ICU.
探讨重症监护病房（ICU）患者谵妄的患病率、危险因素、持续时间及转归。
对2021年9月至11月贵州医科大学附属医院重症医学科收治的危重症患者进行前瞻性观察研究。对符合纳入和排除标准的患者，每天使用里士满躁动镇静量表（RASS）和ICU意识模糊评估法（CAM-ICU）进行两次谵妄评估。记录患者的年龄、性别、体重指数（BMI）、基础疾病、入住ICU时的急性生理与慢性健康状况评估（APACHE）、入住ICU时的序贯器官衰竭评估（SOFA）、氧合指数（PaO/FiO）、诊断、谵妄类型、谵妄持续时间、转归等。根据研究期间是否发生谵妄将患者分为谵妄组和非谵妄组。比较两组患者的临床特征，并采用单因素分析和多因素Logistic回归分析筛选谵妄发生的危险因素。
共纳入347例ICU患者，57.6%（200/347）的患者发生谵妄。最常见的类型是安静型谵妄（占总数的73.0%）。单因素分析显示，两组患者在年龄、入住ICU时的APACHE评分和SOFA评分、吸烟史、高血压、脑梗死病史、免疫抑制、神经系统疾病、脓毒症、休克、血糖（Glu）、入住ICU时的PaO/FiO、ICU住院时间和机械通气时间方面存在统计学显著差异。多因素Logistic回归分析显示，年龄[比值比（OR）=1.045，95%置信区间（95%CI）为1.027-1.063，P<0.001]、入住ICU时的APACHE评分（OR=1.049，95%CI为1.008-1.091，P=0.018）、神经系统疾病（OR=5.275，95%CI为1.825-15.248，P=0.002）、脓毒症（OR=1.941，95%CI为1.117-3.374，P=0.019）和机械通气时间（OR=1.005，95%CI为1.001-1.009，P=0.012）均为ICU患者发生谵妄的独立危险因素。ICU患者谵妄的中位持续时间为2（1，3）天。52%的患者从ICU出院时仍存在谵妄。
ICU患者谵妄的患病率超过50%，安静型谵妄最为常见。年龄、入住ICU时的APACHE评分、神经系统疾病、脓毒症和机械通气时间均为ICU患者发生谵妄的独立危险因素。超过一半的谵妄患者从ICU出院时仍处于谵妄状态。
