APACHEⅡ评分与老年重症肺炎需有创机械通气患者谵妄发生的关系  

Correlation between APACHEⅡ scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation

作　　者：裴兴华[1] 于海明[1] 吴艳红[1] 周煦[1] Pei Xinghua Yu Haiming Wu Yanhong Zhou Xu(Department of Critical Care Medicine, Hunan Provincial People＇s Hospital, Changsha 410005, Hunan, China)

机构地区：[1]湖南省人民医院重症医学科,湖南长沙410005

出　　处：《中华危重病急救医学》2017年第9期821-824,共4页Chinese Critical Care Medicine

基　　金：湖南省卫生计生委科研计划项目（B2017090）

摘　　要：目的 探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分与老年重症肺炎需有创机械通气（MV）患者谵妄发生的关系.方法 采用回顾性研究方法,选择2015年1月至2017年3月湖南省人民医院重症加强治疗病房（ICU）收治的行有创MV治疗的老年重症肺炎患者89例.于有创MV前24 h内进行APACHEⅡ评分;采用ICU意识模糊评估法（CAM-ICU）评估谵妄的发生,并将患者分为谵妄组与非谵妄组,记录两组患者首次谵妄发生时间、MV时间和ICU住院时间.按APACHEⅡ评分将患者分为≤15、16~20、21~25、26~30、31~35、36~40分6组,观察各组谵妄发生率.采用线性回归和Pearson相关法分析患者APACHEⅡ评分与谵妄发生的相关性;绘制受试者工作特征曲线（ROC）,分析APACHEⅡ评分对谵妄发生的预测价值.结果 89例患者均纳入最终分析,其中35例发生谵妄,54例未发生谵妄,谵妄发生率为39.33%,首次谵妄发生时间为（1.85±1.30）d.谵妄组患者MV时间和ICU住院时间较非谵妄组明显延长〔MV时间（d）：9.43±4.77比6.08±3.30,ICU住院时间（d）：14.60±6.59比9.69±4.61,均P〈0.01〕,且谵妄组患者APACHEⅡ评分较非谵妄组明显升高（分：29.89±5.45比21.48±4.76,P〈0.01）,随着APACHEⅡ评分升高,患者谵妄发生率逐渐升高.相关分析显示：老年患者APACHEⅡ评分与首次谵妄发生时间呈显著负相关（r=-0.411,P=0.014）,与谵妄发生率呈线性正相关（r=0.982,P=0.000）,提示APACHEⅡ评分越高,谵妄发生率越高,且首次谵妄发生越早.ROC曲线分析显示：APACHEⅡ评分预测谵妄发生的ROC曲线下面积（AUC）为0.877;当APACHEⅡ评分〉27分时,敏感度为92.59%,特异度为71.43%,阳性预测值为83.33%,阴性预测值为86.21%.结论 随APACHEⅡ评分升高,老年重症肺炎需有创MV患者谵妄发生率逐渐升高,APACHEⅡ评分对此类患者谵妄的发生有预测价值.Objective To investigate the correlation between acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation （MV）.Methods A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit （ICU） of Hunan Provincial People＇s Hospital from January 2015 to March 2017 were enrolled. APACHE Ⅱ scores were collected 24 hours before invasive MV. Consciousness assessment method-ICU （CAM-ICU） was used to diagnose delirium, and the patients were divided into delirium group and non-delirium group. The first delirium occurrence time, duration of MV and the length of ICU stay were recorded. The patients were divided into ≤15, 16-20, 21-25, 26-30, 31-35, 36-40 groups according to APACHEⅡ score, and the incidence of delirium in all groups were observed. The linear regression and Pearson correlation were used to analyze the correlation between APACHE Ⅱ scores and delirium probability. Receiver operating characteristic （ROC） curve was plotted to analyze the predictive effect of APACHEⅡ score on delirium.Results Eighty-nine patients were enrolled in the final analysis, of which 35 had delirium, and 54 had no delirium, with delirium incidence of 39.33%, and the first delirium occurrence time of （1.85±1.30） days. The duration of MV and the length of ICU stay of delirium group were significantly higher than those of non-delirium group [duration of MV （days）： 9.43±4.77 vs. 6.08±3.30, length of ICU stay （days）： 14.60±6.59 vs. 9.69±4.61, bothP 〈 0.01]. The APACHE Ⅱ score in delirium group was significantly higher than that in non-delirium group （29.89±5.45 vs. 21.48±4.76,P 〈 0.01）. With the increase in APACHE Ⅱ scores, the delirium incidence was gradually increased. Correlation analysis showed that there was a negative correlation between APACHE Ⅱ scores and first delirium occurrence time

关 键 词：急性生理学与慢性健康状况评分系统Ⅱ 肺炎 重症 老年 机械通气 谵妄 

分 类 号：R563.1[医药卫生—呼吸系统]