创伤中心严重多发伤患者发生谵妄的危险因素分析

Risk factors of delirium in patients with severe multiple trauma in trauma center

  • 摘要:
    目的  探讨创伤中心严重多发伤患者谵妄的发生情况及其危险因素。
    方法  选取2021年6月—2022年1月收治的168例严重多发伤患者,采用意识模糊评估量表(CAM)评估患者谵妄发生情况,并根据是否发生谵妄,分为谵妄组(n=65)和非谵妄组(n=103)。收集患者资料并分析其发生谵妄的危险因素。
    结果  共收集168例创伤中心严重多发伤患者临床资料,其中发生谵妄患者为65例,发生率为38.69%。2组患者在年龄、机械通气、低氧血症(动脉血氧分压 < 60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度方面比较,差异均有统计学意义(P < 0.05)。多因素Logistic回归分析显示,年龄>60岁、机械通气、低氧血症(动脉血氧分压 < 60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度高急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分>21分是创伤中心严重多发伤患者并发谵妄的独立危险因素。
    结论  创伤中心严重多发伤患者的谵妄发生率较高,其并发谵妄的独立危险因素较多且涉及范围广泛,应及时发现并处理。

     

    Abstract:
    Objective  To investigate the occurrence and risk factors of delirium in patients with severe multiple injuries in trauma center.
    Methods  A total of 168 patients with severe multiple injuries admitted from June 2021 to January 2022 were selected. The occurrence of delirium was assessed by the Confusion Assessment Method (CAM), and the patients were divided into delirium group (n=65) and non-delirium group (n=103) according to whether delirium occurred. The data of patients were collected and the risk factors of delirium were analyzed.
    Results  Clinical data of 168 patients with severe multiple injuries in trauma center were collected, including 65 patients with delirium, with an incidence of 38.69%. There were significant differences in age, mechanical ventilation, hypoxemia (arterial partial pressure of oxygen < 60 mmHg), transferring from ICU to trauma center, coma during trauma, complicating with history of hypertension, brain trauma, invasive operation, and more serious disease between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that age >60 years, mechanical ventilation, hypoxemia (arterial partial pressure of oxygen < 60 mmHg), transferring from ICU to trauma center, coma at the time of trauma, history of hypertension, traumatic brain injury, invasive procedures and severity of illnessAcute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score>21 scoreswere independent risk factors for delirium in patients with severe multiple trauma in trauma center.
    Conclusion  Patients with severe multiple injuries in trauma center have higher incidence of delirium that involves many independent risk factorsand exerts influences in a wide range, so the measures should be taken in time when the problems are detected.

     

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