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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。
Objective To analyze the incidence, risk factors and prognosis of delirium in patients with mechanical ventilation. Methods 472 patients with mechanical ventilation were divided into delirium group and non-delirium group according to whether they were delirium. Multivariate regression analysis was used to analyze the risk factors of delirium. The 90-day survival rate was compared between groups by log-rank test. Results Of the 472 selected patients, 306 had delirium, with a delirium rate of 64.83%. High APACHE II score, prolonged mechanical ventilation, sedation and midazolam acupuncture are risk factors for delirium, and procedural sedation is the protective factor of delirium. The 90-day survival rate was 62.75% in the delirium group and 86.75% in the non-delirium group, with significant difference between the two groups (χ2 = 15.27, P <0.05). The 90-day survival rate was 77.50% in patients with hyper-reactive dexmethasone, 57.52% in patients with low-reactivity and mixed delirium, and there was significant difference between the two groups (χ2 = 8.70, P <0.05). Conclusions There is a high incidence of delirium in patients with mechanical ventilation, high APACHE II score, prolonged mechanical ventilation, sedation of elderly and midazolam are risk factors for delirium, and delirium will reduce the survival rate of patients.