Factors Associated With the Development of Delirium in Elderly Patients in Intensive Care Units

入住加護單位老年病人發生譫妄的影響因素

林維莉(Wei-Li Lin) ； 陳怡芳(Yi-Fan Chen) ； 王琤(Jeng Wang)

《The Journal of Nursing Research》 23卷4期 (2015/12) Pp. 322-329

https://doi.org/10.1097/jnr.0000000000000082

摘要

背景：研究發現加護單位譫妄盛行率高達20%至80%，住院期間發生譫妄常常導致住院日數延長，認知功能退化，甚至需要入住護理之家。目的：因為以加護單位老年病人為研究對象，且討論譫妄的相關研究較少，所以，本研究的目的是建構加護單位老年譫妄的發生率，並且探討影響老年譫妄的危險因子。方法：本研究採觀察法重複測量設計。以年齡大於65歲且入住加護單位24小時內的個案為對象，每日兩次使用加護單位譫妄量表（confusion assessment method, CAM-ICU）和警醒意識程度量表（richmond agitation-sedation scale, RASS）確認譫妄是否發生，收集老年病人的基本資料、疾病史、APACH II（acute physiology and chronic health evaluation II）分數和實驗室檢查值。結果：總共90位老年病人符合收案標準，觀察日數為430天，建立老年譫妄的發生率為75.6%（n = 68）。平均年齡為78.28 ± 7.6，APACH II分數範圍從7 到35，大部份的個案入住加護單位的原因是呼吸衰竭（73.3%），86.76%的個案在入住加護單位24 hours內發生譫妄的症狀，其中混合型最多（47.05%），其次是活動低下型．使用邏輯思回歸檢定老年譫妄的危險因子，包括使用麻醉藥物的數量，用藥的數量，脫水的天數，入住加護單位前使用類固醇以及出現休克情形，共解釋31.3%的變項。結論：老年譫妄是加護單位嚴重的議題，健康照護專業人員應該更加注意評估高危險發生譫妄的老年病人，以達早期發現的目的。

關鍵字

老年病人 ； 危險因子 ； 譫妄 ； 加護單位

並列摘要

Background: High prevalence rates of delirium have been found in intensive care units (ICUs), ranging from 20%to 80%. The development of delirium may prolong length of stay, impair cognition, and result in placement in a nursing home for the patient. Purpose: There is a lack of research focused on the aging population, so the purpose of this study was to establish the incidence rate of delirium among ICU elderly patients and to identify its risk factors. Methods: An observational design with repeated measures was used. Subjects older than 65 years who had been admitted to the ICU within 24 hours were recruited. The Confusion Assessment Method for the Intensive Care Unit and Richmond Agitation-Sedation Scale were used twice a day to identify subjects experiencing delirium by RA. The demographic data, history of illness, Acute Physiology and Chronic Health Evaluation II scores, and laboratory data of the participants were recorded. Results: Ninety participants were included from a medical ICU. The incidence rate of delirium was 75.6% (n = 68). Average age was 78.28 T 7.6 years; Acute Physiology and Chronic Health Evaluation II scores ranged from 7 to 35. Most participants were diagnosed with respiratory failure (73.3%), and 86.76% of participants developed delirium within 24 hours. The most frequently experienced type of delirium was the mixed subtype (47.05%); the second most frequently experienced was hypoactive next. The risk factors were analyzed using logistic regression. The number of anesthetic analgesics used, total number of medications prescribed, duration of dehydration, use of corticosteroids before admissions, and shock were identified and explained 31.3% of variance. Conclusions/Implications for Practice: Delirium is a severe problem among elderly patients in the ICU. Healthcare professionals should pay more attention to elderly patients at greater risk for experiencing delirium.

並列關鍵字

elderly patients ； risk factors ； delirium ； ICU

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