轻度创伤性颅脑损伤患者谵妄发生情况及其影响因素分析  

Incidence of delirium and influencing factors in patients with mild traumatic brain injuries

作　　者：李佳雨 刘素云[1] 莫景书[1] 李海娟[1] 许光远 周小舟 张莹莹 沈印[2] Li Jiayu;Liu Suyun;Mo Jingshu;Li Haijuan;Xu Guangyuan;Zhou Xiaozhou;Zhang Yingying;Shen Yin(Department of Emergency Medicine,the People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning530021,China;International Medical Department,the People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning530021,China)

机构地区：[1]广西壮族自治区人民医院急诊科,南宁530021 [2]广西壮族自治区人民医院国际医疗部,南宁530021

出　　处：《创伤外科杂志》2024年第7期512-516,共5页Journal of Traumatic Surgery

基　　金：广西重点研发计划(桂科AB23026019);广西医疗卫生适宜技术开发与推广项目(S2019076);广西卫生健康委自筹经费科研课题(Z-A20220165/Z-A20230157/Z-A20230145/Z-A20230030)。

摘　　要：目的 探讨轻度创伤性颅脑损伤患者(mTBI)谵妄的发生率及危险因素。方法 前瞻性纳入2021年1月—2023年12月在广西壮族自治区人民医院急诊科住院的107例根据《颅脑创伤临床救治指南》标准诊断为mTBI的患者,患者入院后72 h内每24h采用意识模糊评估法中文修正版(CAM-CR)进行谵妄评估,同时收集患者年龄、性别、合并疾病、入院血清钾、血清钠、血肌酐、血清白蛋白、入院24 h匹兹堡睡眠质量指数(PSQI)等临床指标。根据患者有无谵妄发生分为谵妄组和正常组,比较两组患者的相关临床指标,采用单因素分析和多因素Logistic回归分析筛选患者发生谵妄的危险因素。结果 107例mTBI患者中有41例在住院期间发生谵妄,发生率为38.32%(95%CI:22%~47.7%),谵妄组患者年龄、合并冠心病、高血压病的比例和入院24 h PSQI指数、WBC、CRP数值高于正常组,血清钠、血清钾、血清白蛋白数值低于正常组,两组比较差异有统计学意义(P均<0.05)。Logistic多因素回归分析提示年龄(OR=1.208,95%CI:1.089~1.341)、血清钠(OR=0.758,95%CI:0.624~0.920)、血清白蛋白(OR=0.755,95%CI:0.586~0.971)、入院24 h PSQI指数(OR=2.725,95%CI:1.237~6.002)是mTBI患者住院期间发生谵妄的独立影响因素(P均<0.05)。结论 年龄增加及PSQI指数增加与mTBI患者住院期间发生谵妄风险增加显著相关,血清钠浓度和血清白蛋白水平增加与mTBI患者住院期间发生谵妄风险降低显著相关。Objective To investigate the incidence and risk factors of delirium in patients with mild trau-matic brain injuries(mTBI).Methods A total of 107 patients admitted to the Department of Emergency Medicine of the People’s Hospital of Guangxi Zhuang Autonomous Region from Jan.2021 to Dec.2023 and diagnosed as mT-BI according to the Guidelines for Clinical Treatment of Craniocerebral Trauma were prospectively included.The in-cidence of delirium was evaluated by using the Chinese Revised Version of Confusion Assessment Method(CAM-CR)every 24 h within 72 h after admission.At the same time,clinical indicators such as age,gender,comorbidity,serum potassium,sodium,creatinine,and albumin on admission,and Pittsburgh Sleep Quality Index(PSQI)at 24 h after admission were collected.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not.The relevant clinical indicators of the two groups were compared,and the risk fac-tors of delirium were screened by univariate analysis and multivariate Logistic regression analysis.Results Of the 107 mTBI patients,delirium occurred in 41 during hospitalization,with an incidence of 38.32%(95%CI:22%-47.7%).The delirium group revealed much higher age,proportions of patients with coronary heart disease or hyper-tension,PSQI at 24 h after admission,and WBC and CRP levels,while much lower levels of serum sodium,potassium and albumin,revealing significant differences when compared with the non-delirium group(all P<0.05).Logistic multivariate analysis further showed that age(OR=1.208,95%CI:1.089-1.341),serum sodium(OR=0.758,95%CI:0.624-0.920),serum albumin(OR=0.755,95%CI:0.586~0.971),and PSQI index at 24 h after admission(OR=2.725,95%CI:1.237-6.002)were independent risk factors for the incidence of delirium in mTBI patients during hospitalization(all P<0.05).Conclusion The increase of age and PSQI were significantly associated with the increased risk of delirium incidence during hospitalization of mTBI patients,while the increase of serum sod

关 键 词：创伤性颅脑损伤 谵妄 危险因素 

分 类 号：R651.1[医药卫生—外科学]