- 期刊
Yawning as a Predictor of Survival in Critically Ⅲ Mechanically Ventilated Patients
打哈欠出現在使用呼吸器的重症患者時可視爲一個存活指標
摘要
背景：打哈欠的行為可用來當作中樞dopaminergic system的功能性指標，而其神經控制路徑也屬於與同理心有關的神經網絡活動的一部分。打哈欠的產生也就是此神經功能區運作的表現。因為重症患者常有腦病變的併發症，其發生也會影響預後。此研究即假設以打哈欠做為一種中樞神經功能的表現，來探討打哈欠的出現與否和重症患者的預後是否有關。 方法：從2006年7月到11月，我們前瞻性地研究了99位陸續住到在南部某醫學中心內科加護病房的患者。其打哈欠的發生與頻率由加護病房的照護護士記錄之。然後再以多變數邏輯分析來測定打哈欠與臨床預後的獨立相關性。 結果：不管是否有使用機械通氣，約有一半的患者在加護病房中至少有一次被觀察到有打哈欠的行為。和曾出現打哈欠者比較，未曾出現打哈欠的患者較常有非神經性疾病診斷(p=0.035)、休克(p=0.045)或使用血壓升壓劑(p=0.035)，而且疾病嚴重度較高(p=0.004)。在多變數邏輯分析模型中，我們發現在使用機械通氣的重症患者中，與加護病房死亡率有獨立相關的因素只有兩個：曾出現打哈欠(adjusted odds ratio [OR] 0.24, 95% CI 0.06-0.94, p=0.04)與使用血壓升壓劑(adjusted OR 9.9, 95% CI 2.55-38.45, p=0.001)。 結論：在內科加護病房的重症患者並不常出現打哈欠。然而，若觀察到使用呼吸器的重症患者有打哈欠的行為，將可以期待其預後會較為樂觀。
並列摘要
Objectives: Yawning can be used as a functioning index for the central dopaminergic system and is part of a neural network involved in empathy. The presence of yawning indicates intact functioning in these brain areas. Since encephalopathy occurs frequently in critically ill patients and is associated with patient outcome, we hypothesized that the presence of yawning, as a measure of brain function, might be associated with mortality in critically ill patients. Material and Methods: A total of 99 consecutive patients who were admitted to a medical intensive care unit (ICU) at a tertiary-care hospital between July 1 and November 30, 2006 were prospectively investigated. The occurrence and frequency of yawning were recorded by ICU nursing staff. Multivariate logistic regression was used to determine the independent relationship between yawning and clinical outcomes. Results: About 50% of patients, whether they received invasive mechanical ventilation (MV) or not, had yawned during their ICU stay. Patients who never yawned in the ICU tended to have non-neurological diagnoses (p=0.035) or shock (p=0.045), or used vasopressors (p=0.035), and were more seriously ill as measured by the APACHE Ⅱ score (p=0.004), compared to those who had yawned during their ICU stay. In the logistic regression model, we found that only the presence of yawning (adjusted odds ratio [OR] 0.24, 95% CI 0.06-0.94, p=0.04) and use of vasopressors (adjusted OR 9.9, 95% CI 2.55-38.45, p=0.001) were independently associated with ICU mortality among MV patients. Conclusions: Yawning is a relatively uncommon behavior in the medical ICU, and its occurrence in MV patients predicts a better survival.