谵妄对急性脑出血患者预后的影响  

Influence of delirium on the prognosis of patients with acute cerebral hemorrhage

作　　者：李鸿春 王晓燕 王晓丽 张翠 LI Hongchun;WANG Xiaoyan;WANG Xiaoli;ZHANG Cui(Sunshine Union Hospital,Weifang 261000,China)

机构地区：[1]阳光融和医院,山东潍坊261000

出　　处：《中国实用神经疾病杂志》2024年第10期1289-1292,共4页Chinese Journal of Practical Nervous Diseases

基　　金：潍坊市卫生健康委员会科研项目计划(编号:WFWSJK-2023-168)。

摘　　要：目的探讨脑出血急性期谵妄消退的频率、持续性谵妄和消退性谵妄对预后的影响,以及康复对脑出血谵妄患者预后的影响。方法选取2021-01—2023-01就诊于阳光融和医院神经外科的脑出血患者166例,根据精神障碍诊断与统计手册第五版(DSM-5)诊断是否谵妄,并根据出院状态分为持续性谵妄和消退性谵妄。应用单项因素、二元单因素Logistic回归分析出院后康复地点、谵妄与不良预后的关系。结果166例脑出血患者中98(59%)例住院期间出现谵妄,排除住院死亡21例,62%(48/77)的谵妄患者出院时谵妄消退。Logistic回归分析显示年龄是谵妄的危险因素,谵妄患者出院后接受院外康复的可能性较大(OR=3.11,95%CI:1.15~6.46)。谵妄患者更易出现不良预后(P<0.001),持续性谵妄患者(OR=4.57,95%CI:1.39~15.02)较谵妄消失患者(OR=1.92,95%CI:0.94~3.94)的预后更差。院外康复更易导致不良预后(OR=1.99,95%CI:0.97~4.10)。结论部分脑出血患者的谵妄状态在出院时消失,与持续性谵妄患者相比有更好的预后。谵妄对预后的不良影响可通过住院康复进一步减轻。Objective To investigate the frequency of disappearance of delirium in acute cerebral hemorrhage,the effects of persistent delirium and vanishing delirium on the prognosis,and the effect of rehabilitation on the prognosis of patients with acute cerebral hemorrhage.Methods A total of 166 patients with cerebral hemorrhage in the Department of Neurosurgery of Sunshine Union Hospital from January 2021 to January 2023 were selected.Delirium was diagnosed according to the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders(DSM-5),and was divided into persistent delirium and regression delirium according to the state of discharge.Binary univariate Logistic regression was used to determine the effect of delirium on the poor prognosis of patients with cerebral hemorrhage 3 months after discharge,and an intermediary was used to analyze the effect of different rehabilitation sites on the prognosis.Results Of the 166 patients with cerebral hemorrhage,98(59%)developed delirium during hospitalization,and 62%(48/77)of the patients with delirium subsided at discharge.Logistic regression analysis showed that age was a risk factor for delirium.Delirium patients were more likely to receive out-of-hospital rehabilitation after discharge(OR=3.11,95%CI:1.15-6.46).Delirium was closely related to poor prognosis(P<0.001).The prognosis of patients with persistent delirium(OR=4.57,95%CI:1.39-15.02)was worse than that of patients with disappearance of delirium(OR=1.92,95%CI:0.94-3.94).Out-of-hospital rehabilitation was more likely to lead to poor prognosis(OR=1.99,95%CI:0.97-4.10).Conclusion The delirium state of patients with cerebral hemorrhage disappears at discharge and has a better prognosis than patients with persistent delirium.The adverse effect of delirium on prognosis can be further alleviated by in-hospital rehabilitation.

关 键 词：脑出血 持续性谵妄 消退性谵妄 影响因素 住院康复 

分 类 号：R749.13[医药卫生—神经病学与精神病学]