关键词: 重症监护病房, 认知障碍, 危险因素, 危重患者, 预测模型, 护理

Abstract:

Objective To explore the risk factors of Post-Intense Care Syndrome-Cognitive Impairment（PICS-CI） in critically ill patients,and to build their risk prediction model. Methods A total of 481 ICU patients from 2 Level A tertiary hospitals in Fujian Province were selected,and divided into a cognitive impairment group（n=215） and a non-cognitive impairment group（n=266） according to their cognitive score of 7 days after being transferred out of ICU. The demography,disease,treatment,physiological and laboratory indicators between the 2 groups were compared;the risk factors of PICS-CI were screened out,and Logistic regression was used to establish a risk prediction model. 118 patients from another 4 hospitals were selected to verify the model prediction. Results Age（OR=1.035）,delirium（OR=10.488）,sepsis（OR=1.925）,propofol dose（OR=1.098）,sleep disorder（OR=0.932） are the independent risk factors of PICS-CI. These 5 factors are used to construct a prediction model,which was internally verified by the modeling group. The calibration curve of the calibration chart is close to the ideal curve;the area under the ROC curve is 0.838;the risk prediction value 0.521 corresponding to the maximum Youden index is the best value;the prediction critical value is 50 points. The external verification shows that the calibration curve of the calibration chart is near the ideal curve,and the area under the ROC curve drawn is 0.797. Conclusion The PICS-CI prediction model constructed in this study shows good prediction efficiency. ICU patients with scores≥50 should receive close attention and early interventions in early stage.

Key words: Intensive Care Units, Cognition Disorders, Risk Factors, Critical Patients, Prediction Model, Nursing Gare