新型冠状病毒疫情期间RICU患者抑郁和急性脑病综合征发生情况及危险因素分析  

Analysis of the incidence and risk factors of depression and delirium syndrome of patients in RICU during COVID-19 epidemic

作　　者：张祖莉[1] 刘雨村[1] 李凤增[2] ZHANG Zu-li;LIU Yu-cun;LI Feng-zeng(Department of Respiratory and Critical Care Medicine,Chongqing 400016,China;Department of Dermatology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院呼吸与危重症医学科,重庆400016 [2]重庆医科大学附属第一医院皮肤科,重庆400016

出　　处：《临床肺科杂志》2021年第2期196-201,共6页Journal of Clinical Pulmonary Medicine

基　　金：国家临床重点专科护理建设项目资助(财社[2010]305号)。

摘　　要：目的了解新型冠状病毒肺炎疫情期间,呼吸与危重症医学科监护室(RICU)患者发生抑郁及急性脑病综合征的情况,分析危险因素,为采取心理干预和减少急性脑病综合征发生提供依据。方法选择2020年1月25日至2020年3月25日入住RICU的患者,在住院期间采用健康抑郁症状群量表(PHQ-9)对患者进行抑郁评分,并采用ICU患者意识模糊评估单(CAM-ICU)对患者进行急性脑病综合征的评估。收集患者人口学资料、病情资料及对疫情的担忧情况,分析患者发生抑郁和急性脑病综合征的危险因素。结果81例患者中发生抑郁48例(59.3%),发生急性脑病综合征38例(46.9%)。PHQ-9抑郁评分在合并疾病数量、是否营养失调以及是否担心疫情感染的患者间差异有显著性(P<0.05)。发生急性脑病综合征的患者在合并疾病种类、使用呼吸机占比方面及营养失调比例,显著高于未发生急性脑病综合征患者(P<0.05)。Logistic回归分析显示,女性患者、呼吸困难、担心被新冠病毒感染是发生抑郁的重要危险因素(P<0.05),年龄、抑郁评分、合并多种疾病、使用无创呼吸机、发热是发生急性脑病综合征的重要危险因素(P<0.05)。结论除了患者本身病情外,新型冠状病毒肺炎疫情在很大程度上增加RICU患者的抑郁情绪,进而提高急性脑病综合征发生率。因此,在此类重大突发性公共卫生事件时,可以积极采取针对性的预防措施,以缓解RICU患者的抑郁情绪,降低急性脑病综合征的发生率。Objective To explore the incidence of depression and delirium syndrome of patients in respiratory intensive care unit(RICU)during epidemic of COVID-19 and analyze the risk factors in order to provide evidence for psychological intervention and reduction of the incidence of delirium.Methods Patients who were admitted into RICU from January 25,2020,to March 25,2020,were enrolled in this study.The depression of patients was assessed using the Healthy Depression Symptom Group Scale(PHQ-9),and the ICU delirium was assessed using the confusion assessment method of the intensive care unit(CAM-ICU)during hospitalization.Demographic data,disease data,and concerns about the epidemic were collected to look for the risk factors of depression and delirium syndrome.Results In a total of 81 patients,there were 48 patients(59.3%)with depression and 38 patients(46.9%)with ICU delirium.Depression(PHQ-9)scores in patients with more combined diseases,malnourishment,more fear and panic about COVID-19 were significantly higher than those in other patients(P<0.05).The number of combined diseases,the proportion of ventilator used,and the percentage of malnourishment in the delirium patients were significantly higher than those in the delirium-free patients(P<0.05).Logistic regression analysis showed that female patients,dyspnea,and the fear of being infected by the COVID-19 were significant risk factors for depression(P<0.05).Age,depression score,multiple combined diseases,applications of noninvasive mechanical ventilation,and fever were significant risk factors for ICU delirium(P<0.05).Conclusion In addition to the patients′illness,the epidemic situation of COVID-19 can significantly increase the depression of patients in RICU,thereby increasing the incidence of delirium syndrome.Therefore,during such major public health emergencies,targeted preventive measures can be actively taken to relieve depression and reduce the incidence of delirium syndrome of patients in RICU.

关 键 词：抑郁 急性脑病综合征 危险因素 

分 类 号：R742[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]