摘要
目的 探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分与老年重症肺炎需有创机械通气（MV）患者谵妄发生的关系.方法 采用回顾性研究方法,选择2015年1月至2017年3月湖南省人民医院重症加强治疗病房（ICU）收治的行有创MV治疗的老年重症肺炎患者89例.于有创MV前24 h内进行APACHEⅡ评分;采用ICU意识模糊评估法（CAM-ICU）评估谵妄的发生,并将患者分为谵妄组与非谵妄组,记录两组患者首次谵妄发生时间、MV时间和ICU住院时间.按APACHEⅡ评分将患者分为≤15、16~20、21~25、26~30、31~35、36~40分6组,观察各组谵妄发生率.采用线性回归和Pearson相关法分析患者APACHEⅡ评分与谵妄发生的相关性;绘制受试者工作特征曲线（ROC）,分析APACHEⅡ评分对谵妄发生的预测价值.结果 89例患者均纳入最终分析,其中35例发生谵妄,54例未发生谵妄,谵妄发生率为39.33%,首次谵妄发生时间为（1.85±1.30）d.谵妄组患者MV时间和ICU住院时间较非谵妄组明显延长〔MV时间（d）：9.43±4.77比6.08±3.30,ICU住院时间（d）：14.60±6.59比9.69±4.61,均P〈0.01〕,且谵妄组患者APACHEⅡ评分较非谵妄组明显升高（分：29.89±5.45比21.48±4.76,P〈0.01）,随着APACHEⅡ评分升高,患者谵妄发生率逐渐升高.相关分析显示：老年患者APACHEⅡ评分与首次谵妄发生时间呈显著负相关（r=-0.411,P=0.014）,与谵妄发生率呈线性正相关（r=0.982,P=0.000）,提示APACHEⅡ评分越高,谵妄发生率越高,且首次谵妄发生越早.ROC曲线分析显示：APACHEⅡ评分预测谵妄发生的ROC曲线下面积（AUC）为0.877;当APACHEⅡ评分〉27分时,敏感度为92.59%,特异度为71.43%,阳性预测值为83.33%,阴性预测值为86.21%.结论 随APACHEⅡ评分升高,老年重症肺炎需有创MV患者谵妄发生率逐渐升高,APACHEⅡ评分对此类患者谵妄的发生有预测价值.
Objective To investigate the correlation between acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation （MV）.Methods A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit （ICU） of Hunan Provincial People＇s Hospital from January 2015 to March 2017 were enrolled. APACHE Ⅱ scores were collected 24 hours before invasive MV. Consciousness assessment method-ICU （CAM-ICU） was used to diagnose delirium, and the patients were divided into delirium group and non-delirium group. The first delirium occurrence time, duration of MV and the length of ICU stay were recorded. The patients were divided into ≤15, 16-20, 21-25, 26-30, 31-35, 36-40 groups according to APACHEⅡ score, and the incidence of delirium in all groups were observed. The linear regression and Pearson correlation were used to analyze the correlation between APACHE Ⅱ scores and delirium probability. Receiver operating characteristic （ROC） curve was plotted to analyze the predictive effect of APACHEⅡ score on delirium.Results Eighty-nine patients were enrolled in the final analysis, of which 35 had delirium, and 54 had no delirium, with delirium incidence of 39.33%, and the first delirium occurrence time of （1.85±1.30） days. The duration of MV and the length of ICU stay of delirium group were significantly higher than those of non-delirium group [duration of MV （days）： 9.43±4.77 vs. 6.08±3.30, length of ICU stay （days）： 14.60±6.59 vs. 9.69±4.61, bothP 〈 0.01]. The APACHE Ⅱ score in delirium group was significantly higher than that in non-delirium group （29.89±5.45 vs. 21.48±4.76,P 〈 0.01）. With the increase in APACHE Ⅱ scores, the delirium incidence was gradually increased. Correlation analysis showed that there was a negative correlation between APACHE Ⅱ scores and first delirium occurrence time （r = -0.411,P = 0.014）, and a significant linear positive correlation between APACHE Ⅱ scores and delirium incidence in all patients was found （r = 0.982, P = 0.000）, which indicated the higher APACHE Ⅱ scores, the higher delirium incidences and the earlier first delirium occurrence time was. ROC curve analysis showed that the area under ROC curve （AUC） of APACHE Ⅱ scores on predicting delirium occurrence was 0.877, when the cut-off value of APACHE Ⅱ score was over 27, the sensitivity was 92.59%, the specificity was 71.43%, the positive predictive value was 83.33%, and the negative predictive value was 86.21%.Conclusions With the increase in APACHE Ⅱ score, the incidence of delirium was increased gradually in senile severe pneumonia patients receiving invasive MV. APACHE Ⅱ score played an important clinical value in evaluating the delirium probability of these patients
作者
裴兴华
于海明
吴艳红
周煦
Pei Xinghua Yu Haiming Wu Yanhong Zhou Xu(Department of Critical Care Medicine, Hunan Provincial People＇s Hospital, Changsha 410005, Hunan, China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第9期821-824,共4页
Chinese Critical Care Medicine
基金
湖南省卫生计生委科研计划项目（B2017090）
