ICU患者亚谵妄综合征患病率及危险因素的系统评价

doi:10.3761/j.issn.0254-1769.2020.02.023

摘要/Abstract

摘要：

目的系统评价ICU患者亚谵妄综合征患病率现状及危险因素,为早期识别ICU患者亚谵妄综合征的发生风险提供证据支持。方法检索PubMed、Embase、PsycINFO、Cochrane Library、中国生物医学文献服务系统、中国知网、维普和万方数据库,检索时间为建库至2019年6月,纳入评价ICU患者亚谵妄综合征患病率及其影响因素的文献,应用Stata 14.0软件对亚谵妄综合征发生率进行单组Meta分析,采用固定效应或随机效应模型进行数据合并,用Begg秩相关和漏斗图判定发表偏倚。对影响因素采取描述性分析。结果共纳入13篇文献,涉及5 396例ICU患者,发表时间为2007年—2019年。Meta分析结果显示,ICU患者亚谵妄综合征发生率为36.9%[95%CI（0.22~0.52）],亚组分析显示,女性、老年ICU、亚洲地区患者亚谵妄综合征患病率更高;描述性分析显示,影响ICU患者亚谵妄综合征发生的因素包括年龄、基础疾病、认知障碍、药物镇静等。结论 ICU患者亚谵妄综合征发生率较高,高龄、基础疾病、认知障碍以及应用药物镇静等可增加患者发生亚谵妄综合征的风险。但纳入文献整体研究样本量不大,研究质量不高,建议后续开展多中心大样本研究,进一步探索ICU亚谵妄综合征患病率和危险因素。

关键词: 重症监护病房, 亚谵妄综合征, 患病率, 危险因素, 系统评价

Abstract:

Objective To determine the prevalence and risk factors of subsyndromal delirium （SSD） in adult intensive care unit patients by systematically reviewing evidence. Methods PubMed,Embase,PsycINFO,Cochrane Library,CBM,CNKI,VIP and Wanfang were searched from inception to 2019 for potentially relevant articles. Stata 14.0 software was used to analyze the prevalence of subsyndromal delirium with a single group meta-analysis. Fixed-effect or random-effect models were used to merge data. Begg rank correlation and funnel plot were used to determine publication bias. Descriptive analysis was used to analyze the influencing factors. Results 13 studies（5396 ICU patients） were included. The combined prevalence of subsyndromal delirium was 36.9%[95%CI（0.22~0.52）]. Subgroup analysis showed that the prevalence of subsyndromal syndrome was higher in women,elderly ICU and patients Asia. Possible risk factors included age,severity of diseases,cognitive impairment,and drug sedation. Conclusion There is a certain prevalence of subsyndromal delirium in ICU patients（36.9%）. Age,underlying diseases,cognitive impairment,and drug sedation are possible risk factors. However,the overall sample size of the study is not large and the quality of the study is quite poor. It is suggested that large-sample multi-centered studies should be carried out in future to further explore the prevalence and risk factors of subsyndromal delirium in ICU patients.

Key words: Intensive Care Units, Subsyndromal Delirium, Prevalence, Risk Factors, Systematic Review

李真, 李奇, 李尊柱, 孙建华, 罗红波, 张燕妮. ICU患者亚谵妄综合征患病率及危险因素的系统评价[J]. 中华护理杂志, 2020, 55(2): 288-293.

LI Zhen, LI Qi, LI Zunzhu, SUN Jianhua, LUO Hongbo, ZHANG Yanni. Prevalence and risk factors of subsyndromal delirium among adult intensive care unit patients:a systematic review[J]. Chinese Journal of Nursing, 2020, 55(2): 288-293.

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参考文献 26

[1]	Cole MG, Ciampi A, Belzile E , et al. Subsyndromal delirium in older people:a systematic review of frequency,risk factors,course and outcomes[J]. Int J Geriatr Psychiatry, 2013,28(8):771-780.
[2]	Levkoff SE, Liptzin B, Cleary PD , et al. Subsyndromal delirium[J]. Am J Geriatr Psychiatry, 1996,4(4):320-329.
[3]	Serafim RB, Soares M, Bozza FA , et al. Outcomes of subsyndromal delirium in ICU:a systematic review and meta-analysis[J]. Crit Care, 2017,21(1):179.
[4]	Klimiec-Moskal E, Lis A, Pera J , et al. Subsyndromal delirium is associated with poor functional outcome after ischaemic stroke[J]. Eur J Neurol, 2019,26(6):927-934.
[5]	孙丹丹, 梁涛 . 亚谵妄综合征相关研究进展[J]. 中国护理管理, 2016,16(10):1426-1429.
[6]	Ouimet S, Riker R, Bergeron N , et al. Subsyndromal delirium in the ICU:evidence for a disease spectrum[J]. Intensive Care Med, 2007,33(6):1007-1013.
[7]	吴传芹, 李国宏 . 护士评估ICU谵妄的研究进展[J]. 中华护理杂志, 2017,52(9):1124-1128.
[8]	Yamada C, Iwawaki Y, Harada K , et al. Frequency and risk factors for subsyndromal delirium in an intensive care unit[J]. Intensive Crit Care Nurs, 2018,47:15-22.
[9]	Brummel NE, Boehm LM, Girard TD , et al. Subsyndromal delirium and institutionalization among patients with critical illness[J]. Am J Crit Care, 2017,26(6):447-455.
[10]	胡玲, 胡三莲, 钱会娟 . 亚谵妄综合征的诊断标准研究进展[J]. 护理研究, 2019,33(7):1158-1161.
[11]	余翔, 封秀琴, 徐菊玲 , 等. 亚谵妄早期识别与干预研究的进展[J]. 护士进修杂志, 2018,33(7):608-610.
[12]	刘琴, 陆骏, 宁丽 , 等. 亚谵妄综合征的评估及护理研究进展[J]. 解放军护理杂志, 2017,34(22):37-39,44.
[13]	刘琴 . 综合性医院重症监护室护士亚谵妄综合征知信行现况调查研究[D]. 杭州:浙江中医药大学, 2017.
[14]	Rostom A, Dube C, Cranney A ,et al. Celiac Disease. Rockville(MD):Agency for Healthcare Research and Quality(US); 2004 Sep.( Evidence Reports/Technology Assessments,No. 104.) Appen-dix D. Quality Assessment Forms[EB/OL].( 2014-09)[2019-05-22]. .
[15]	Tan MC, Felde A, Kuskowski M , et al. Incidence and predictors of post-cardiotomy delirium[J]. Am J Geriatr Psychiatry, 2008,16(7):575-583.
[16]	Zuliani G, Bonetti F, Magon S , et al. Subsyndromal delirium and its determinants in elderly patients hospitalized for acute medical illness[J]. J Gerontol A Biol Sci Med Sci, 2013,68(10):1296-1302.
[17]	Lam CY, Tay L, Chan M , et al. Prospective observational study of delirium recovery trajectories and associated short-term outcomes in older adults admitted to a specialized delirium unit[J]. J Am Geriatr Soc, 2014,62(9):1649-1657.
[18]	Li HC, Chen YS, Chiu MJ , et al. Delirium,subsyndromal delirium,and cognitive changes in individuals undergoing elective coronary artery bypass graft surgery[J]. J Cardiovasc Nurs, 2015,30(4):340-345.
[19]	Breu A, Stransky M, Metterlein T , et al. Subsyndromal delirium after cardiac surgery[J]. Scand Cardiovasc J, 2015,49(4):207-212.
[20]	Al-Qadheeb NS, Skrobik Y, Schumaker G , et al. Preventing ICU subsyndromal delirium conversion to delirium with low-dose IV haloperidol[J]. Crit Care Med, 2016,44(3):583-591.
[21]	Boettger S, Nuñez DG, Meyer R , et al. Subsyndromal delirium in the intensive care setting:Phenomenological characteristics and discrimination of subsyndromal delirium versus no and full-syndromal delirium[J]. Palliat Support Care, 2018,16(1):3-13.
[22]	Sanson G, Khlopenyuk Y, Milocco S , et al. Delirium after cardiac surgery. Incidence,phenotypes,predisposing and precipitating risk factors,and effects[J]. Heart Lung, 2018,47(4):408-417.
[23]	Azuma K, Mishima S, Shimoyama K , et al. Validation of the prediction of delirium for intensive care model to predict subsyndromal delirium[J]. Acute Med Surg, 2019,6(1):54-59.
[24]	Bastos AS, Beccaria LM, Silva DCD , et al. Identification of delirium and subsyndromal delirium in intensive care patients[J]. Rev Bras Enferm, 2019,72(2):463-467.
[25]	黄洁, 肖倩, 吴瑛 , 等. ICU谵妄危险因素的Meta分析[J]. 中华护理杂志, 2010,45(1):6-9.
[26]	吴琼, 江智霞, 潘燕彬 , 等. 机械通气患者发生谵妄的影响因素分析[J]. 中华护理杂志, 2018,53(5):543-548.