作者：杨福政，胡艺

单位：

1.扬州大学护理学院·公共卫生学院2.扬州大学附属医院教育处

Units：

1.SchoolofNursing·SchoolofPublicHealth,YangzhouUniversity,Yangzhou225009,China2.EducationCluster,AffiliatedHospitalofYangzhouUniversity,Yangzhou225003,China

关键词：

谵妄; ICU; 老年人; 危险因素; Meta分析;

Keywords：

Delirium;Intensivecareunit;Aged;Riskfactors;Meta-analysis

CLC：

R741.041

DOI：

10.12114/j.issn.1008-5971.2023.00.056

Funds：

摘要：

目的 系统评价ICU老年患者发生谵妄的危险因素。方法 使用计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library公开发表的ICU老年患者发生谵妄危险因素的病例对照研究和队列研究，对照组为未发生谵妄的老年患者，病例组为发生谵妄的老年患者。检索时限为建库至2022-09-20。提取纳入文献的资料，采用纽卡斯尔-渥太华量表（NOS）进行质量评价，采用RevMan 5.4软件进行Meta分析。结果 本研究纳入33篇文献，共7 636例患者，其中病例组3 016例、对照组4 620例。Meta分析结果显示，年龄增长、营养状况差、脑卒中史、痴呆史、认知功能下降、急性生理与慢性健康评价系统Ⅱ（APACHEⅡ）评分升高、低血压、低氧血症、疼痛、机械通气、应用镇静药物、身体约束、睡眠剥夺是ICU老年患者发生谵妄的危险因素（P<0.05）。单篇文献研究结果显示，合并症多、美国麻醉医师协会（ASA）分级升高、ICU住院时间延长是ICU老年患者发生谵妄的危险因素（P<0.05）。结论 现有证据显示，年龄增加、营养状况差、脑卒中史、痴呆史、认知功能下降、APACHEⅡ评分升高、低血压、低氧血症、疼痛、机械通气、应用镇静药物、身体约束、睡眠剥夺、合并症多、ASA分级高、ICU住院时间长是ICU老年患者发生谵妄的危险因素。受纳入研究数量、质量以及样本量的限制，仍待更多大样本、多中心的前瞻性研究进行证实。

Abstract：

ObjectiveTosystematicallyevaluatetheriskfactorsofdelusionsinelderlypatientsinICU.Methods DatabasesincludingCNKI,WanfangData,VIP,CBM,PubMed,Embase,WebofScience,CochraneLibrary,wereretrievedtosearchforcase-controlstudiesandcotortstudiesontheriskfactorsofdelusionsinelderlypatientsinICUfrominceptionto20September,2022.Thecontrolgroupwaselderlypatientswithoutdelirium,andthecasegroupwaselderlypatientswithdelirium. Thedataoftheincludedliteraturewereextracted,theNewcastle-OttawaScale(NOS)wasusedtoevaluatethequalityoftheincludedliterature,RevMan5.4wasusedformeta-analysis.ResultsAtotalof33articleswereincluded,andinvolving7636patients,including3016casesincasegroupand4620casesincontrolgroup.Meta-analysisresultsshowedthatincreasedage,poornutritionalstatus,historyofstroke,historyofdementia,cognitivedecline,increasedacutephysiologyandchronichealthevaluationⅡ (APACHEⅡ)score,hypotension,hypoxemia,pain,mechanicalventilation,applicationofsedativedrugs,physicalrestraintandsleepdeprivationwereriskfactorsofdelusionsinelderlypatientsinICU(P<0.05).Theresultsofasingleliteraturestudyshowedthatincreasedcomplications,increasedAmericanAssociationofAnesthesiologists(ASA)classification,andprolongedstayinICUwereriskfactorsofdelusionsinelderlypatientsinICU(P<0.05).ConclusionTheavailableevidenceshowsthatincreasedage,poornutritionalstatus,historyofstroke,historyofdementia,cognitivedecline,increasedAPACHEⅡscore,hypotension,hypoxemia,pain,mechanicalventilation,applicationofsedativedrugs,physicalrestraint,sleepdeprivation,increasedcomplications,increasedASAclassification,andprolongedstayinICUareriskfactorsofdelusionsinelderlypatientsinICU.Duetothelimitationsofthenumber,qualityandsamplesizeoftheincludedstudies,theaboveconclusionsstillneedtobeconfirmedbymorehigh-qualitystudies.

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