Investigation on the status of ICU patients with delirium after heart valve replacement
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摘要:目的 调查心脏瓣膜置换术后患者在ICU期间的谵妄发生情况并分析其影响因素。方法 选择514例心脏瓣膜置换术后患者，应用ICU意识模糊评估量表(CAM-ICU)对其进行谵妄评估，并分析其影响因素。结果 514例瓣膜置换术后患者中，有108例发生谵妄，谵妄发生率为21.01%;单因素分析结果表明，年龄、体外循环时间、呼吸机辅助呼吸时间、入住ICU时间、医疗支付方式、合并症、瓣膜种类与ICU谵妄的发生密切相关; 多因素Logistic回归分析结果显示，年龄、体外循环时间、入住ICU时间、合并症及瓣膜种类是心脏瓣膜置换术后患者发生ICU谵妄的独立危险因素。结论 心脏瓣膜置换术后患者ICU谵妄发生率处于较高水平，患者年龄越大、体外循环时间越长、入住ICU时间越长、有高血压及糖尿病合并症者、机械瓣膜置换术者，越容易发生ICU谵妄，医护人员可针对患者发生ICU谵妄的相关影响因素采取相应措施加以预防。Abstract:Objective To investigate the status of ICU patients with delirium after heart valve replacement, and to explore the influencing factors.Methods A total of 514 patients after heart valve replacement were selected, and were assessed by Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Meanwhile, its influencing factors were analyzed.Results Out of 514 patients with valve replacement, delirium occurred in 108 cases, with its incidence rate of 21.01%. Univariate analysis showed that age, extracorporeal circulation time, ventilator assisted breathing time, length of stay in ICU, mode of medical payment, complications and valve type were closely related to the incidence of delirium in ICU. Multivariate Logistic regression analysis showed that age, extracorporeal circulation time, length of stay in ICU, complications and valve type were independent risk factors for ICU delirium after heart valve replacement.Conclusion The incidence of ICU delirium in patients after heart valve replacement is high. The patients with elder age, longer cardiopulmonary bypass time as well as ICU stay, complicating with hypertension and diabetes, mechanical valve replacement, are more prone to suffer ICU delirium. In view of the relevant factors affecting the occurrence of ICU delirium, medical staff should take corresponding measures to prevent its occurrence.
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Keywords:
- valve replacement /
- ICU /
- delirium /
- influence factor /
- breathing machine /
- extracorporeal circulation
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表 1 心脏瓣膜置换术后患者ICU谵妄影响因素的单因素分析(x±s)[n(%)]
因素 谵妄组(n=108) 非谵妄组(n=406) t或χ2 P 年龄/岁 65.52±8.23 60.07±8.57 -5.922 < 0.010 医疗费用支付方式 自费 78(72.22) 250(61.58) 2.928 0.004 医保 30(27.78) 156(38.42) 合并症 无 15(13.89) 102(25.12) -2.155 0.032 有 93(86.11) 304(74.88) 体外循环时间/min 119.69±38.21 87.14±26.51 -4.351 < 0.010 呼吸机辅助呼吸时间/h 30.65±57.06 23.25±32.09 -1.766 0.048 入住ICU时间/h 186.15±169.64 89.15±89.67 -8.054 < 0.010 瓣膜种类 机械瓣 88(81.48) 276(67.98) -2.758 0.006 生物瓣 20(18.52) 130(32.02) 
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表 2 心脏瓣膜置换术后患者ICU谵妄多因素Logistic回归分析
变量 B BE Wals Exp(B) Exp(B)的95%CI P 年龄 0.131 0.021 38.550 1.140 (1.094~1.189) < 0.001 体外循环时间 0.008 0.002 20.436 1.008 (1.004~1.011) < 0.001 入住ICU时间 0.008 0.001 50.288 1.008 (1.006~1.010) < 0.001 合并症 0.567 0.326 3.024 1.763 (1.093~3.339) 0.038 瓣膜种类 0.664 0.311 4.556 1.943 (1.056~3.576) 0.033
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