中华护理杂志 ›› 2021, Vol. 56 ›› Issue (1): 14-20.DOI: 10.3761/j.issn.0254-1769.2021.01.002
收稿日期:
2020-04-06
出版日期:
2021-01-15
发布日期:
2021-01-15
通讯作者:
李红
作者简介:
魏月清:女,本科(硕士在读),主管护师,E-mail: WEI Yueqing(),LI Hong(),LI Yun,WU Jingbing,ZHANG Zhihong,ZHENG Yan
Received:
2020-04-06
Online:
2021-01-15
Published:
2021-01-15
Contact:
Hong LI
摘要:
目的 探讨危重症患者发生ICU后认知障碍的危险因素,并构建其风险预测模型。 方法 2019年1月—10月,选取福建省某2所三级甲等综合性医院的危重症患者481例,根据患者转出ICU后7 d认知功能分为认知障碍组(n=215)和非认知障碍组(n=266),将两组间一般资料、疾病因素、治疗因素、实验室检查指标等进行比较,筛选出独立危险因素并利用Logistic回归进行风险预测模型的构建,2019年11月—12月,选取福建省另外4所医院的危重症患者118例对模型进行验证。 结果 最终纳入年龄(OR=1.035)、谵妄(OR=10.488)、脓毒症(OR=1.925)、丙泊酚累积剂量(OR=1.098)、睡眠评分(OR=0.932)5个因素构建出风险预测模型。内部验证:Calibration图示校准曲线与理想曲线接近重合;ROC曲线下面积为0.838;最大Youden指数所对应的风险预测值为0.521,预测临界值为50分。外部验证:Calibration图示校准曲线在理想曲线附近;ROC曲线下面积为0.797。 结论 该研究所构建的ICU后认知障碍风险预测模型一致性和预测效能较好,对于分数≥50分的危重患者,应高度关注其是否有认知障碍,并实施早期干预。
魏月清,李红,李芸,吴静冰,张智宏,郑艳. ICU后认知障碍风险预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(1): 14-20.
WEI Yueqing,LI Hong,LI Yun,WU Jingbing,ZHANG Zhihong,ZHENG Yan. Construction of a risk prediction model for post-intensive care syndrome-cognitive impairment[J]. Chinese Journal of Nursing, 2021, 56(1): 14-20.
表1 建模组长沙版蒙特利尔认知评估量表的总分及各维度的平均分
Tab.1 Total score and average score for each sub-project on the Montreal Cognitive Assessment Scale(Changsha Version) of the development group
[1] | 韦秀霞, 张秀伟, 彭剑英, 等. 国外ICU后综合征的研究现状[J]. 中华护理杂志, 2016,51(1):84-89. |
Wei XX, Zhang XW, Peng JY, et al. Current research status on post-intensive care syndrome[J]. Chin J Nurs, 2016,51(1):84-89. | |
[2] |
Wolters AE, Slooter AJC,van der Kooi AW,et al. Cognitive im-pairment after intensive care unit admission:a systematic review[J]. Intensive Care Med, 2013,39(3):376-386.
DOI URL PMID |
[3] | 邵聪, 顾立学, 梅永霞, 等. 重症加强治疗后综合征患者发生认知障碍的危险因素分析[J]. 中华危重病急救医学, 2017,29(8):716-720. |
Shao C, Gu LX, Mei YX, et al. Analysis of the risk factors of cognitive impairment in post-intensive care syndrome patient[J]. Chin Crit Care Med, 2017,29(8):716-720. | |
[4] | 王璐璐. 脓毒症幸存者认知功能临床研究[D]. 天津:天津医科大学, 2018. |
Wang LL. The clinical study of cognitive function in survivors of sepsis[D]. Tianjin:Tianjin Medical University, 2018. | |
[5] | 李宝宝. 成人心脏术后ICU后综合征发生现状及影响因素的研究[D]. 济南:山东大学, 2018. |
Li BB. The present status and influencing factors of post-intensive care syndrome in adult after cardiac surgery[D]. Ji Nan:Shandong University, 2018. | |
[6] | Suchyta MR, Jephson A, Hopkins RO. Neurologic changes during critical illness:brain imaging findings and neurobehavioral outcomes[J]. Brain Imaging Behav, 2010,41(1):22-34. |
[7] |
Ehlenbach WJ, Hough CL, Crane PK, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults[J]. JAMA, 2010,303(8):763-770.
DOI URL PMID |
[8] |
Schulte PJ, Martin DP, Deljou A, et al. Effect of cognitive status on the receipt of procedures requiring anesthesia and critical care admissions in older adults[J]. Mayo Clin Proc, 2018,93(11):1552-1562.
DOI URL PMID |
[9] |
Hassan MM, Hwang LY, Hatten CJ, et al. Risk factors for hepatocellular carcinoma:synergism of alcohol with viral hepatitis and diabetes mellitus[J]. Hepatology, 2002,36(5):1206-1213.
DOI URL PMID |
[10] |
Dimitri GF, Figueira SJI, Avila CR, et al. The confusion assessment method for the intensive care unit(CAM-ICU) and intensive care delirium screening checklist(ICDSC) for the diagnosis of delirium:a systematic review and meta-analysis of clinica[J]. Crit Care, 2012,16(4):R115.
DOI URL PMID |
[11] | 杨慧, 孙丹丹, 李尊柱, 等. 中文版理查兹-坎贝尔睡眠量表应用于ICU患者的信效度研究[J]. 中国护理管理, 2017,17(5):601-604. |
Yang H, Sun DD, Li ZZ, et al. Reliability and validity of the Chinese version of Richards Campbell Sleep Questionnaire among ICU patients[J]. Chin Nurs Manag, 2017,17(5):601-604. | |
[12] | 靳慧. 长沙版蒙特利尔认知评估量表的形成及在中国湖南地区缺血性脑血管病人群中的应用[D]. 长沙:中南大学, 2011. |
Jin H. Development of Changsha Montreal cognitive assessment scale and its application in patients with ischemic cere-brovascular disease in Hunan Province of China[D]. Chang sha:Central South University, 2011. | |
[13] | 黄菲芸, 王艳红, 李娟娟, 等. 蒙特利尔认知评估量表在中国中老年人群筛查轻度认知功能障碍中的截断值的系统评价[J]. 中国循证医学杂志, 2017,17(4):450-457. |
Huang FY, Wang YH, Li JJ, et al. Diagnostic value of montreal cognitive assessment for mild cognitive impairment in Chinese middle-aged adults:a meta-analysis[J]. Chin J Evidence-Based Medi, 2017,17(4):450-457. | |
[14] |
Chung CR, Yoo HJ, Park J, et al. Cognitive impairment and psychological distress at discharge from intensive care unit[J]. Psychiatry Investig, 2017,14(3):376-379.
DOI URL PMID |
[15] |
Günther ML, Morandi A, Krauskopf E, et al. The association between brain volumes,delirium duration,and cognitive outcomes in intensive care unit survivors:the VISIONS cohort magnetic resonance imaging study[J]. Crit Care Med, 2012,40(7):2022-2032.
DOI URL PMID |
[16] |
Semmler A, Widmann CN, Okulla T, et al. Persistent cognitive impairment,hippocampal atrophy and EEG changes in sepsis survivors[J]. J Neurol Neurosurg Psychiatry, 2013,84(1):62-69.
DOI URL PMID |
[17] | 姚丽, 丁楠楠, 杨丽平, 等. 重症患者转出ICU后认知损害危险因素的Meta分析[J]. 中国护理管理, 2018,18(12):1634-1643. |
Yao L, Ding NN, Yang LP, et al. Risk factors for cognitive impairment after critical illness:a meta-analysis[J]. Chin Nurs Manag, 2018,18(12):1634-1643. | |
[18] |
Van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium:when cytokines and acetylcholine collide[J]. Lancet, 2010,375(9716):773-775.
DOI URL PMID |
[19] |
Sakusic A, O horo JC, Dziadzko M, et al. Potentially modifiable risk factors for long-term cognitive impairment after critical illness:a systematic review[J]. Mayo Clin Proc, 2018,93(1):68-82.
DOI URL PMID |
[20] |
Ehlenbach WJ, Bykovskyi AG, Repplinger MD, et al. Sepsis survivors admitted to skilled nursing facilities cognitive impairment,activities of daily living dependence,and survival[J]. Crit Care Med, 2017,46(1):37-44.
DOI URL PMID |
[21] |
Bozza FA, D’avila JC, Ritter C, et al. Bioenergetics,mitochondrial dysfunction,and oxidative stress in the pathophysiology of septic encephalopathy[J]. Shock, 2013,39(7):10-16.
DOI URL |
[22] | 陶香君, 丁舒, 冯新伟, 等. 心脏术后患者认知功能障碍危险因素的Meta分析[J]. 中华护理杂志, 2016,51(7):773-780. |
陶香君, 丁舒, 冯新伟, 等. 心脏术后患者认知功能障碍危险因素的Meta分析[J]. 中华护理杂志, 2016,51(7):773-780. | |
Tao XJ, Ding S, Feng XW, et al. Risk factors for cognitive impairment after cardiac surgical procedures:a meta-analysis[J]. Chin J Nurs, 2016,51(7):773-780. | |
Tao XJ, Ding S, Feng XW, et al. Risk factors for cognitive impairment after cardiac surgical procedures:a meta-analysis[J]. Chin J Nurs, 2016,51(7):773-780. | |
[23] | 张真真, 王群, 张丽洁, 等. 中青年2型糖尿病住院患者的认知功能特点及影响因素研究[J]. 中华护理杂志, 2018,53(2):190-194. |
张真真, 王群, 张丽洁, 等. 中青年2型糖尿病住院患者的认知功能特点及影响因素研究[J]. 中华护理杂志, 2018,53(2):190-194. | |
Zhang ZZ, Wang Q, Zhang LJ, et al. The cognitive function characteristics and influencing factors of cognitive impairment in young and middle-aged inpatients with type 2 diabetes[J]. Chin J Nurs, 2018,53(2):190-194. | |
Zhang ZZ, Wang Q, Zhang LJ, et al. The cognitive function characteristics and influencing factors of cognitive impairment in young and middle-aged inpatients with type 2 diabetes[J]. Chin J Nurs, 2018,53(2):190-194. | |
[24] |
Fleischman DA, Leurgans S, Arfanakis K, et al. Gray-matter ma-crostructure in cognitively healthy older persons:associations with age and cognition[J]. Brain Struct Funct, 2014,219(6):2029-2049.
DOI URL PMID |
Fleischman DA, Leurgans S, Arfanakis K, et al. Gray-matter ma-crostructure in cognitively healthy older persons:associations with age and cognition[J]. Brain Struct Funct, 2014,219(6):2029-2049.
DOI URL PMID |
|
[25] | Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult Brain[J]. Science, 2013,342(6156):1-11. |
Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult Brain[J]. Science, 2013,342(6156):1-11. | |
[26] |
Beltrami FG, Nguyen XL, Pichereau C, et al. Sleep in the intensive care unit[J]. J Bras Pneumol, 2015,41(6):539-546.
DOI URL PMID |
Beltrami FG, Nguyen XL, Pichereau C, et al. Sleep in the intensive care unit[J]. J Bras Pneumol, 2015,41(6):539-546.
DOI URL PMID |
|
[27] |
Davydow DS, Zatzick D, Hough CL, et al. In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission[J]. Ann Am Thorac Soc, 2013,10(5):450-457.
DOI URL PMID |
Davydow DS, Zatzick D, Hough CL, et al. In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission[J]. Ann Am Thorac Soc, 2013,10(5):450-457.
DOI URL PMID |
|
[28] |
Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness:its role in physical andpsychological recovery[J]. J Intensive Care Med, 2012,27(2):97-111.
DOI URL PMID |
Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness:its role in physical andpsychological recovery[J]. J Intensive Care Med, 2012,27(2):97-111.
DOI URL PMID |
|
[29] |
Mueller AD, Mear RJ, Mistlberger RE. Inhibition of hippocampal neurogenesis by sleep deprivation is independent of circadian disruption and melatonin suppression[J]. Neuroscience, 2011,193:170-181.
DOI URL PMID |
Mueller AD, Mear RJ, Mistlberger RE. Inhibition of hippocampal neurogenesis by sleep deprivation is independent of circadian disruption and melatonin suppression[J]. Neuroscience, 2011,193:170-181.
DOI URL PMID |
|
[30] |
Wei Y, Hu J, Liang Y, et al. Dexmedetomidine pretreatment attenuates propofol-induced neurotoxicity in neuronal cultures from the rat hippocampus[J]. Mol Med Rep, 2016,14(4):3413-3420.
DOI URL PMID |
Wei Y, Hu J, Liang Y, et al. Dexmedetomidine pretreatment attenuates propofol-induced neurotoxicity in neuronal cultures from the rat hippocampus[J]. Mol Med Rep, 2016,14(4):3413-3420.
DOI URL PMID |
|
[31] | 于文娟, 朱敏, 沃雁, 等. 丙泊酚镇静对大鼠海马BDNF-TrkB_ p75信号和认知功能的影响[J]. 上海交通大学学报(医学版), 2018,38(6):594-597. |
于文娟, 朱敏, 沃雁, 等. 丙泊酚镇静对大鼠海马BDNF-TrkB_ p75信号和认知功能的影响[J]. 上海交通大学学报(医学版), 2018,38(6):594-597. | |
Yu WJ, Zhu M, Wo Y, et al. Effects of propofol sedation on BDNF-TrkB/p75 signal and cognitive function in rat hippo-campus[J]. J Shanghai Jiaotong University(Medical Science), 2018,38(6):594-597. | |
Yu WJ, Zhu M, Wo Y, et al. Effects of propofol sedation on BDNF-TrkB/p75 signal and cognitive function in rat hippo-campus[J]. J Shanghai Jiaotong University(Medical Science), 2018,38(6):594-597. | |
[32] |
Guo L, Lin F, Dai H, et al. Impact of sevoflurane versus pro-pofol anesthesia on post-operative cognitive dysfunction in elderly cancer patients:a double-blinded randomized controlled trial[J]. Med Sci Monit, 2020,26:e919293.
DOI URL PMID |
Guo L, Lin F, Dai H, et al. Impact of sevoflurane versus pro-pofol anesthesia on post-operative cognitive dysfunction in elderly cancer patients:a double-blinded randomized controlled trial[J]. Med Sci Monit, 2020,26:e919293.
DOI URL PMID |
|
[33] |
Hong W, Earnest A, Sultana P, et al. How accurate are vital signs in predicting clinical outcomes in critically ill emergency department patients[J]. Eur J Emerg Med, 2013,20(1):27-32.
DOI URL |
Hong W, Earnest A, Sultana P, et al. How accurate are vital signs in predicting clinical outcomes in critically ill emergency department patients[J]. Eur J Emerg Med, 2013,20(1):27-32.
DOI URL |
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