Abstract:

Objective To investigate the current status of delirium of terminal cancer patients,and to explore the influencing factors and provide evidence for clinical early assessment and screening. Methods Data of terminal cancer patients were collected from a hospice care unit from October 2016 to March 2018. Logistic regression model was used to analyze the independent influencing factors of delirium in terminal cancer patients. Results This study included 231 patients with 139 cases of delirium,and the incidence of delirium was 60.2%. Score of Eastern Cooperative Oncology Group（ECOG）,Palliative Prognostic Index（PPI）,medicine type（opioids,benzodiazepines,corticosteroids）,polypharmacy（drug types≥3）,symptom（infection,sleep disorder,constipation,hypoxia,cachexia）,liver/kidney failure,electrolyte imbalance,brain metastasis,and immobilization were related to delirium（P<0.05）;Logistic regression model showed that using opioids（OR=1.477）,infection（OR=3.782）,sleep disturbance（OR=4.209）,and PPI（OR=6.285） were independent influencing factors of delirium. Conclusion The incidence of delirium of terminal cancer patients is still high. The use of opioids,infection,sleep disturbance,and PPI can cause delirium. Health staff should evaluate influencing factors early to decrease the incidence of delirium.

Key words: Neoplasms, Terminally Ill, Delirium, Influencing Factors, Hospice Care

摘要：

目的 调查癌症终末期患者发生谵妄的现状,探讨其发生谵妄的影响因素,为谵妄的早期评估和筛查提供依据。方法 收集2016年10月—2018年3月入住安宁病房的癌症终末期患者资料,将单因素分析差异有统计学意义的变量进行Logistic回归分析,探讨癌症终末期患者发生谵妄的独立影响因素。结果 共纳入231例癌症终末期患者,发生谵妄139例,发生率60.2%。单因素分析结果显示,美国东部肿瘤协作组织体力状态评分、姑息预后指数评分、药物类型（阿片类、苯二氮?类、皮质类固醇类）、多药合用（使用药物≥3种）、症状（感染、睡眠障碍、便秘、缺氧、癌性恶病质）、肝或肾功能衰竭、电解质紊乱、脑转移、活动受限等与癌症终末期患者发生谵妄有关（P<0.05）;Logistic回归分析显示,使用阿片类药物（OR=1.477）、感染（OR=3.782）、睡眠障碍（OR=4.209）和姑息预后指数评分（OR=6.285）是癌症终末期患者发生谵妄的独立影响因素。结论 癌症终末期患者谵妄的发生率处于较高水平,使用阿片类药物、感染、睡眠障碍、姑息预后指数评分增高可诱发谵妄,临床医护人员应早期评估和筛查这些影响因素,以降低谵妄的发生率。

关键词: 肿瘤, 临终病人, 谵妄, 影响因素, 临终关怀医疗