谵妄对重症监护病房急性心肌梗死患者住院病死率的影响  

The effect of delirium on in-hospital mortality in patients with acute myocardial infarction in intensive care unit

作　　者：李智博[1] 蒋芸杰 杨姗姗 王淑春 杨其霖[1] 周德扬 颜婷 耿蕊 赵宁[3] LI Zhibo;JIANG Yunjie;YANG Shanshan;WANG Shuchun;YANG Qilin;ZHOU Deyang;YAN Ting;GENG Rui;ZHAO Ning(Department of Intensive Care Medicine,the Second Hospital of Guangzhou Medical Univer-sity,Guangzhou 510260,China;不详)

机构地区：[1]广州医科大学附属第二医院重症医学科,广州510260 [2]广州医科大学第二临床学院,广州510260 [3]广州医科大学附属第二医院心血管疾病研究所,广州510260

出　　处：《实用医学杂志》2022年第23期2952-2956,共5页The Journal of Practical Medicine

基　　金：广东省医院协会围术期管理临床科研基金(编号:KT-WSQ-2020016);广州市卫生和计划生育科技项目(编号:20181A010055);广州医科大学附属第二医院新技术、新业务临床研究项目(编号:2020-LCYJ-XJS-08)。

摘　　要：目的探讨急性心肌梗死患者谵妄发生和住院病死率的关系。方法采用回顾性队列研究,收集美国重症监护医学信息数据库(MIMIC-IV)的急性心肌梗死患者。根据是否谵妄,分为谵妄组和无谵妄组。采用逆概率加权等多种方法,评估急性心肌梗死患者谵妄发生和住院病死率的独立关系。结果发生谵妄的急性心肌梗死患者住院病死率较无谵妄组高67%(逆概率加权结果:HR=1.67,95%CI:1.30~2.15,P<0.001),使用多因素Cox回归、调整倾向性评分、倾向性评分匹配、逆概率比加权和双稳健分析模型敏感分析显示,HR在1.45~1.54,结果稳定。同时E值为2.73,提示考虑未控制的混杂因素,结果依然稳定。结论在重症监护病房的急性心肌梗死患者,谵妄的发生和住院病死率增加独立相关。Objective To investigate whether delirium associated with in-hospital mortality in patients with acute myocardial infarction.Methods This study used a retrospective cohort.The US Medical Information in Intensive Care database(MIMIC-IV)of patients with acute myocardial infarction was used to evaluate the independent relationship between delirium and in-hospital mortality.To evaluate the independent relationship between delirium and in-hospital mortality,inverse probability weighting was applied.Results Acute myocardial infarction patients with delirium had an in-hospital mortality rate that was 67%greater than those without delirium(inverse probability weighted result:HR=1.67,95%CI:1.30~2.15,P<0.001).Sensitivity analyses utilizing Cox regression,adjusted propensity scores,propensity score matching,inverse probability weighting,and double robust analysis models revealed that the HR varied from 1.45 to 1.65.E value of 2.73 indicated that the results remain stable when considered uncontrolled confounding factors.)Conclusion Delirium was independently associated with increased in-hospital mortality in patients with acute myocardial infarction in the intensive care unit.

关 键 词：谵妄 重症监护病房 急性心肌梗死 住院病死率 

分 类 号：R543.5[医药卫生—心血管疾病]