机械通气患者谵妄高危因素及预后分析

目的：分析机械通气患者谵妄的发生率、高危因素及预后情况。方法472例机械通气患者根据是否谵妄分为谵妄组和非谵妄组，采用多因素回归分析谵妄发生的高危因素，采用log-rank检验比较两组患者90 d生存率。结果472例入选患者中有306例发生谵妄，谵妄发生率为64.83%。高APACHEⅡ评分、机械通气时间延长、高龄及咪达唑仑针镇静是谵妄的危险因素，程序性镇静是谵妄的保护因素。谵妄组90 d生存率为62.75%，非谵妄组为86.75%，两组比较差异具有统计学差异（χ2=15.27，P＜0.05）。高反应性谵妄组90 d生存率为77.50%，低反应性和混合性谵妄组生存率为57.52%，两组比较差异具有统计学差异（χ2=8.70，P＜0.05）。结论机械通气患者存在较高的谵妄发生率，高APACHEⅡ评分、机械通气时间延长、高龄及咪达唑仑镇静是谵妄发生的危险因素，谵妄会降低患者的生存率。

Risk factors and prognosis of delirium in patients with mechanical ventilation

Objective To investigate the risk factors and prognosis of delirium in patients with mechanical ventilation. Methods Consecutive patients with mechanical ventilation were divided into the delirium group and the non-delirium group. Multivariate logistic regression analysis was used to analyze risk factors of delirium. 90-day survival rate between the two groups was compared by Log-rank test. Results Total 306 cases in 472 cases suffered from delirium, the incidence of delirium was 64.83%. Higher APACHE II score, prolonged mechanical ventilation, older age and midazolam sedation were independent high risk factors of delirium while programmed sedation was the protective factor. 90-day survival rate were 62.75%in the delirium group and 86.75%in the non-delirium group, the difference was statistically significant（χ2=15.27, P〈0.05）. 90-day survival rate were 77.50% in hyperergy delirium group and 57.52% in hypoergia and hybrid delirium groups, the difference was statistically significant （χ2=8.70,P〈0.05）. Conclusion The incidence rate of delirium is rela-tively higher in patients with mechanical ventilation. Higher APACHE Ⅱ score, prolonged mechanical ventilation, older age and midazolam sedation were independent high risk factors of delirium. 90-day survival rate would be decreased by delirium.