PICU机械通气治疗患儿谵妄发生情况及其影响因素分析  

Delirium in pediatric intensive care unit with mechanical ventilation:analysis of incidence and influencing factors

作　　者：许莉莉[1,3] 马朱圣颖 钱雯 许雅雅 朱月钮 朱晓东[1] 戈晓华[2] XU Lili;MA Zhushengying;QIAN Wen;XU Yaya;ZHU Yueniu;ZHU Xiaodong;GE Xiaohua(Department of Pediatric Critical Care Medicine,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Nursing Department,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属新华医院儿急危重症医学科,上海200092 [2]上海交通大学医学院附属新华医院护理部,上海200092 [3]上海交通大学护理学院,上海200025

出　　处：《临床儿科杂志》2024年第5期445-449,共5页Journal of Clinical Pediatrics

基　　金：上海交通大学医学院护理学科建设项目(No.HX3295);2023年上海交通大学医学院护理科研面上项目(No.Jyh2303)。

摘　　要：目的探讨儿科重症监护室(PICU)内接受机械通气(MV)治疗的患儿发生谵妄(PD)概率及其相关影响因素。方法回顾性分析2022年7月至2023年3月在医院PICU内接受MV治疗患儿的临床资料。结果149例患儿接受MV,中位年龄2.0(1.0~6.0)岁,男74例、女75例。其中年龄≤2岁患儿86例(57.7%),治疗期间反复气管插管患儿34例(22.8%)。149例患儿中有81例(54.4%)发生谵妄,与非谵妄组相比,谵妄组年龄较小,俯卧位通气比例较低,年龄≤2岁比例较高,PICU住院时间延长,PICU住院时间>14天比例较高,差异有统计学意义(P<0.05)。与非谵妄组相比,谵妄组MV首日氧合指数≤150 mmHg比例较高,MV总时间较长,MV总时间≤168 h比例较低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示患儿PICU住院时间>14 d、MV首日氧合指数≤150 mmHg是MV患儿发生谵妄的独立危险因素(P<0.05),而MV总时间≤168 h是MV患儿发生谵妄的保护因素(P<0.05)。结论PICU内接受MV治疗的患儿谵妄发生率较高,与低氧性损伤密切相关。长时间的MV和PICU住院治疗也是导致谵妄发生的重要影响因素。Objective To investigate the prevalence of delirium(PD) in children receiving mechanical ventilation(MV) treatment in the pediatric intensive care unit(PICU) and its related influencing factors.Methods The clinical data of children receiving MV treatment in the PICU from July 2022 to March 2023 were retrospectively analyzed.Results 149 children received MV,with a median age of 2.0(1.0-6.0) years,74 males and 75 females.Among them,86 children(57.7%)were aged ≤2 years,and 34 children(22.8%) were repeatedly intubated during treatment.Among 149 children,81(54.4%)had delirium.Compared with the non-delirium group,the delirium group was younger,had a lower proportion of prone position ventilation,a higher proportion of age ≤ 2 years,a longer PICU length of stay,and a higher proportion of PICU length of stay > 14 days,with statistically significant differences(P< 0.05).Compared with the non-delirium group,the delirium group had a higher proportion of oxygenation index ≤ 150mmHg on the first day of MV,a longer total MV time,and a lower proportion of total MV time ≤168 h,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that PICU length of stay > 14 days and oxygenation index ≤ 150 mmHg on the first day of MV were independent risk factors for delirium in children with MV(P<0.05),while total MV time ≤ 168 h was a protective factor for delirium in children with MV(P<0.05).Conclusions The prevalence of delirium in children receiving MV treatment in PICU is higher,which is closely related to hypoxic injury.Long-term MV and PICU hospitalization are also important factors contributing to the development of delirium.

关 键 词：儿科重症监护室 机械通气 谵妄 氧合指数 

分 类 号：R720.597[医药卫生—急诊医学]