Analysis of related factors of early cognitive dysfunction in patients with septic shock after recovery
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摘要: 目的 筛查感染性休克患者愈后并发早期认知功能障碍可能的临床相关因素。 方法 选择2015年1月—2019年12月亳州市人民医院重症监护室(ICU)收治的124例感染性休克愈后患者,根据蒙特利尔认知评估量表中文版评分,分为认知功能障碍组CI组(cognitive impairment,33例)和无认知功能障碍组NCI组(no cognitive impairment,91例),收集患者年龄、入住ICU最高急性生理学与慢性健康状况评分-Ⅱ(APACHE-Ⅱ评分)、去甲肾上腺素(norepinephrine,NE)总用量、苯二氮卓类药物(benzodiazepine,BZD)总用量、丙泊酚注射液药物(propofol,PROP)总用量、阿片类药物总用量、住ICU时间、机械通气时间、血清超敏C蛋白(hs-CRP)最高值,动脉血乳酸(LAC)最高值、谵妄持续时间。比较2组临床资料,对患者早期认知功能障碍因素进行单因素筛选和多因素logistic回归分析。 结果 感染性休克患者愈后并发早期认知功能障碍发生率为26.61%(33/124)。单因素筛查,CI组患者年龄、谵妄持续时间[(67.19±6.55)岁、(32.97±27.59)h]均大于NCI组[(50.96±11.94)岁、(3.29±4.48)h],差异有统计学意义(均P<0.05)。多因素logistic回归分析示年龄(OR=1.279,95%CI:1.128~1.451,P<0.001)、谵妄持续时间(OR=1.355,95%CI:1.169~1.571,P<0.001)为感染性休克患者愈后并发早期认知功能障碍的独立危险因素。 结论 感染性休克患者愈后3个月并发早期认知功能障碍发生率较高。高龄和ICU期间谵妄持续时间是其独立危险因素。临床医护人员对年龄较大和(或)谵妄持续时间较长的感染性休克患者应尽早采取措施缩短谵妄持续时间并及早筛查是否存在认知功能障碍。Abstract: Objective To explore the influencing factors of early cognitive dysfunction in patients with septic shock after recovery. Methods Total 124 patients with septic shock in intensive care unit(ICU) of Bozhou people's hospital from January 2015 to December 2019 were divided into cognitive impairment group(33 cases, CI group) and non-cognitive impairment group(91 cases, NCI group) according to the Montreal Assessment Scale Cognitive(Chinese version). Data of patients were collected, which included, age, the highest acute physiology, chronic health score-Ⅱ(APACHE-Ⅱ), total norepinephrine(NE), total benzodiazepine(BZD), total propofol(PROP), total opioid dosage, time in ICU, time of mechanical ventilation, the highest content of serum high sensitive C protein(hs-CRP), the highest value of arterial blood lactic acid(LAC), and the duration of delirium. The clinical data of the two groups were compared. The single factor screening and multifactor logistic regression analysis of early cognitive impairment in patients with septic shock after ICU cure were performed. The early cognitive impairment factors in patients was analyzed by univariate screening and multivariate logistic regression analysis. Results The incidence of early cognitive impairment in post-intensive care patients with septic shock was 26.61%(33/124). The age and duration of delirium in CI group[(67.19±6.55) year,(32.97±27.59) h)] were higher than those in NCI group[(50.96±11.94) year,(3.29±4.48) h](all P<0.05). Multivariate logistic regression analysis indicated that the age(OR=1.279, 95% CI:1.128-1.451, P<0.001) and the duration of delirium(OR=1.355, 95% CI:1.69-1.571, P<0.001)) were risk factors for cognitive impairment post-intensive care patients with septic shock. Conclusion The incidence of early cognitive impairment(3 months) is higher in patients with septic shock after recovery. The age and duration of delirium are the main influencing factors of early cognitive dysfunction(within 3 months) in those patients. Clinical staff should take measures to shorten the duration of delirium as early as possible and screen for cognitive impairment in patients with septic shock who are older or have a longer duration of delirium.
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Key words:
- Risk factor /
- Cognitive dysfunction /
- Septic shock
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