基于精神心理因素构建的重症监护病房患者谵妄危险预测模型  

Construction of delirium risk prediction model for patients in intensive care unit based on psychological factors

作　　者：王娇[1] 郑秋兰[2] 曾聪 盛孝敏[2] Wang Jiao;Zheng Qiulan;Zeng Cong;Sheng Xiaomin(Department of Orthopaedic Joint Surgery,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Nursing,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院骨科关节外科,重庆400010 [2]重庆医科大学附属第二医院护理部,重庆400010

出　　处：《中国中西医结合急救杂志》2024年第2期223-228,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：重庆市科卫联合医学科研项目(2018QNXM022,2019MSXM044)。

摘　　要：目的基于谵妄发生的相关精神心理风险因素,构建重症监护病房(ICU)患者谵妄危险预测模型,为ICU患者谵妄识别提供新的思路。方法采用前瞻性观察研究方法。选择2019年9月至2020年9月重庆医科大学附属第二医院中心ICU收治的165例患者作为研究对象。采用一般资料问卷、艾森克人格问卷简式量表中文版(EPQ-RSC)、状态-特质焦虑量表(STAI)、汉密尔顿抑郁量表(HAMD)、特质应对方式问卷(TCSQ)、ICU意识模糊评估法(CAM-ICU)问卷进行调查,采用二元Logistic回归模型筛选ICU患者发生谵妄的危险因素,并以此构建列线图模型验证该模型的准确性。结果剔除无效数据7例后,最终纳入158例患者,其中共23例发生谵妄,谵妄发生率为14.56%。单因素分析显示,与未发生谵妄组比较,发生谵妄组患者年龄明显增大(岁:72.91±6.75比63.36±10.14),有酗酒史、认知障碍史和机械通气史的患者比例均明显增加〔有酗酒史:17.4%(4/23)比5.2%(7/135),有认知障碍史:30.4%(7/23)比5.2%(7/135),有机械通气史:78.3%(18/23)比40.7%(55/135),均P<0.05〕,ICU住院时间明显延长(d:7.26±1.66比4.93±2.15),神经质评分(分:7.78±2.66比5.07±2.77)、消极应对评分(分:30.70±6.54比25.76±5.41)、HAMD抑郁评分(分:15.04±4.55比10.76±3.77)、特质焦虑评分(分:49.48±7.14比44.10±8.66)均明显升高(均P<0.05)。Logistic回归分析显示,年龄、神经质评分、HAMD抑郁评分、特质焦虑评分、ICU住院时间、有机械通气史均是影响ICU患者发生谵妄的危险因素〔优势比(OR)和95%可信区间(95%CI)分别为1.11(1.02~1.22)、1.50(1.13~1.99)、1.39(1.15~1.69)、1.13(1.03~1.25)、1.47(1.04~2.06)、6.52(1.19~35.73),P值分别为0.02、0.01、0.01、0.01、0.03、0.03〕,并据此构建列线图模型,其受试者工作特征曲线(ROC曲线)下面积(AUC)=0.96,95%CI为0.93~0.99,约登指数为0.87,其敏感度为100%,特异性为87%,Hosmer-Lemeshow拟合优度检验结果:χ2=5.13,P=0.74,提Objective To construct a delirium risk prediction model for patients in the intensive care unit(ICU)based on the related psychological risk factors of delirium,and provide a new idea for the identification of delirium in ICU patients.Methods A prospective observational study method was conducted.From September 2019 to September 2020,a total of 165 patients in the department of ICU of the Second Affiliated Hospital of Chongqing Medical University were selected as the research objects.The patients were assessed by general information questionnaire,eysenck personality questionnaire-revised,short scale for Chinese(EPQ-RSC),state-trait anxiety inventory(STAI),Hamilton depression scale(HAMD),trait coping style questionnaire(TCSQ),and confusion assessment method of ICU(CAM-ICU).The binary Logistic regression model was used to explore the risk factors of delirium in ICU patients,and a nomogram model was constructed to verify the accuracy of the model.Results After excluding 7 cases of invalid data,158 patients were finally included,23 were believed to be suffering from delirium,and the incidence of delirium was 14.56%.The univariate analysis showed that compared with the non-delirium group,the age of patients was significantly increased(years:72.91±6.75 vs.63.36±10.14),the proportion of patients with history of alcoholism,cognitive impairment and mechanical ventilation in the delirium group was significantly increased[history of alcoholism:17.4%(4/23)vs.5.2%(7/135),history of cognitive impairment:30.4%(7/23)vs.5.2%(7/135),history of mechanical ventilation:78.3%(18/23)vs.40.7%(55/135),all P<0.05],the length of ICU stay was significantly prolonged(days:7.26±1.66 vs.4.93±2.15),the neuroticism score(7.78±2.66 vs.5.07±2.77),the negative coping score(30.70±6.54 vs.25.76±5.41),the HAMD depression score(15.04±4.55 vs.10.76±3.77),and the trait anxiety score(49.48±7.14 vs.44.10±8.66)were significantly increased(all P<0.05).Logistic regression analysis showed that age,neuroticism score,HAMD depression score,trait anxiet

关 键 词：重症监护病房 谵妄 预测模型 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]