慢性阻塞性肺疾病机械通气患者发生谵妄的危险因素分析  

The risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease

作　　者：袁继印 刘景刚[1] 张贵真 杨圣强[1] 杨文宝[1] YUAN Jiyin;LIU Jinggang;ZHANG Guizhen;YANG Shengqiang;YANG Wenbao(Department of Intensive Care Unit,Affiliated Huxi Hospital of Jining Medical College(Shanxian Central Hospital),Shanxian,Shandong 274300,P.R.China)

机构地区：[1]济宁医学院附属湖西医院(单县中心医院)重症医学科

出　　处：《中国呼吸与危重监护杂志》2019年第6期522-526,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：山东省医药卫生科技发展计划项目(2015WS0467)

摘　　要：目的探讨慢性阻塞性肺疾病(简称慢阻肺)机械通气患者发生谵妄的危险因素。方法选择2018年1月至2018年10月济宁医学院附属湖西医院重症医学科收治的97例慢阻肺非高血压机械通气患者为研究对象,根据重症加强治疗病房意识模糊评估法将患者分为谵妄组49例和非谵妄组48例。采集患者机械通气前(d0)和机械通气第3(d3)、5(d5)天的pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血浆神经元特异性烯醇化酶(NSE),计算急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,记录两组患者机械通气时间。Logistic回归分析筛选影响患者谵妄的危险因素。结果谵妄组患者PaCO2、NSE、APACHEⅡ评分、机械通气时间高于非谵妄组[(88.1±7.5)比(85.3±6.2)mm Hg;(28.4±5.8)比(26.1±3.3)μg/L;(23.7±3.9)比(21.7±2.6)分;(7.5±1.3)比(6.6±1.2)d],而PaO2低于非谵妄组[(54.9±5.5)mm Hg比(57.2±3.1)mm Hg],差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,PaO2、NSE、APACHEⅡ评分、机械通气时间是慢阻肺机械通气患者发生谵妄的危险因素(回归系数分别为–0.177、0.163、0.203、0.597,P<0.05)。两组患者机械通气第3、5 d的PaO2、APACHEⅡ评分[d3(88.3±5.3)比(89.1±6.9)mm Hg;d5(90.3±9.0)比(91.3±6.4)mm Hg;d3(21.7±3.0)比(21.4±2.2)分;d5(20.9±2.8)比(20.7±2.1)分]差异无统计学意义(P>0.05)。机械通气第3、5 d的NSE[d3(30.0±5.3)比(26.8±3.6)μg/L;d5(27.3±4.3)比(25.7±2.6)μg/L]比较,差异有统计学意义(P<0.05)。结论PaO2、NSE、APACHEⅡ评分、机械通气时间是慢阻肺机械通气患者发生谵妄的危险因素,NSE是更重要的危险因素之一。Objective To investigate the risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease(COPD).Methods A total of 97 mechanically ventilated non-hypertensive patients with COPD who were admitted to this department from January 2018 to October 2018 were selected as subjects.The patients were divided into 49 cases with delirium and 48 cases non-delirium according to the Consciousness Assessment Method for the Intensive Care Uint.The examined data were collected in the patients such as p H,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),neuron-specific enolase(NSE),and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores were calculated in the pre-mechanical(d0)and mechanically ventilated 3 rd(d3),5 th(d5)days.The mechanical ventilation days were recorded in the two groups.Logistic regression analysis was used to screen the risk factors influencing delirium of patients.Results The PaCO2,NSE,APACHEⅡscores and mechanical ventilation days were higher in the delirium group than in the non-delirium group[(88.1±7.5)vs.(85.3±6.2)mm Hg;(28.4±5.8)vs.(26.1±3.3)μg/L;(23.7±3.9)vs.(21.7±2.6);(7.5±1.3)d vs.(6.6±1.2)d]and PaO2 were lower than non-delirium group[(54.9±5.5)vs.(57.2±3.1)mm Hg],the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that PaO2,NSE,APACHEⅡscores and mechanical ventilation days were risk factors for delirium in mechanically ventilated patients with COPD(regression coefficients were–0.177,0.163,0.203,0.597 respectively,P<0.05).The PaO2 and APACHEⅡscores of mechanical ventilation on the 3 rd and 5 th day of the two groups[d3(88.3±5.3)vs.(89.1±6.9)mm Hg;d5(90.3±9.0)vs.(91.3±6.4)mm Hg;d3(21.7±3.0)vs.(21.4±2.2);d5(20.9±2.8)vs.(20.7±2.1)]were not statistically significant(P>0.05).The NSE changes on the 3 rd and 5 th day of mechanical ventilation[d3(30.0±5.3)vs.(26.8±3.6)μg/L;d5(27.3±4.3)vs.(25.7±2.6)μg/L]were statistically signifi

关 键 词：肺疾病 慢性阻塞性 呼吸 人工 谵妄 危险因素 

分 类 号：R47[医药卫生—护理学]