目的:评估重症监护病房(ICU)患者亚综合征性谵妄(SSD)的持续时间以及与SSD持续时间相关的因素。
方法:这项回顾性研究包括2019年12月至2020年6月入住南通大学附属医院ICU的成年患者。所有Richmond躁动镇静量表评分≥-2分的患者每8小时采用重症监护病房(CAM-ICU)的混淆评估方法进行评估,直至SSD患者阴性,进展为谵妄,陷入昏迷,死了,或从ICU出院。进行多变量Cox回归分析以确定与SSD持续时间相关的因素。
结果:在388名患者中,53.6%拥有SSD,20.7%从SSD进展到谵妄。SSD的持续时间为8到248小时,中位持续时间为48小时(四分位距,24-72).年龄(危险比[HR]=0.985,95%置信区间[CI],0.971-0.999,p=0.035),手术与否(HR=0.514;95%CI,0.310-0.850;p=0.010),通气时间(HR=1.003;95%CI,1.000-1.006;p=0.044),缺氧持续时间(HR=0.212;95%CI,0.103-0.438;p<0.001),和适应的认知考试成绩(HR=1.057;95%CI,1.030-1.085;p<0.001)与SSD持续时间独立相关。
结论:SSD的持续时间与年龄有关,手术,通风持续时间,缺氧的持续时间,和认知功能。SSD在ICU患者中发病率较高,许多患者进展为谵妄。
■研究小组在整个项目中与评估小组的公众成员进行了一系列研讨会。研讨会知情研究设计,数据收集工具和数据解释。
结论:ICU工作人员应注意年龄较大的SSD患者,手术史,更长的通风时间,缺氧持续时间延长,降低ACE得分。
OBJECTIVE: To evaluate the duration of subsyndromal delirium (SSD) in intensive care unit (ICU) patients and the factors associated with SSD
duration.
METHODS: This retrospective study included adult patients admitted to the ICU of Affiliated Hospital of Nantong University between December 2019 and June 2020. All patients with Richmond Agitation Sedation Scale scores of ≥-2 were evaluated every 8 h using the confusion assessment method of the intensive care unit (CAM-ICU) until the patients with SSD were negative, progressed to delirium, fell into a coma, died, or were discharged from the ICU. Multivariable Cox regression analyses were performed to determine the factors associated with SSD duration.
RESULTS: Of the 388 patients, 53.6% had SSD, and 20.7% progressed from SSD to delirium. The
duration of SSD ranged from 8 to 248 h, and the median
duration was 48 h (interquartile range, 24-72). Age (hazard ratio [HR] = 0.985, 95% confidence interval [CI], 0.971-0.999, p = 0.035), surgery or not (HR = 0.514; 95% CI, 0.310-0.850; p = 0.010), duration of ventilation (HR = 1.003; 95% CI, 1.000-1.006; p = 0.044), duration of hypoxia (HR = 0.212; 95% CI, 0.103-0.438; p < 0.001), and adapted cognitive exam scores (HR = 1.057; 95% CI, 1.030-1.085; p < 0.001) were independently associated with the duration of SSD.
CONCLUSIONS: The
duration of SSD was associated with age, surgery,
duration of ventilation,
duration of hypoxia, and cognitive function. SSD has a high incidence among ICU patients, and many patients progress to delirium.
UNASSIGNED: The study team met with public members of the evaluation teams throughout the project in a series of workshops. Workshops informed study design, data collection tools and data interpretation.
CONCLUSIONS: ICU staff should pay attention to SSD patients with older age, history of surgery, longer duration of ventilation, prolonged
duration of hypoxia, and lower ACE scores.