Analyzing Incidence Of Delirium And Influencing Factors In Patients With Severe Analgesia And Sedation In ICU

Objective: To study the incidence of delirium in patients with severe analgesia and sedation in the First Affiliated Hospital of Xinjiang Medical University and analyze the influencing factors.Methods: First,select patients who were admitted to the ICU of the First Affiliated Hospital of Xinjiang Medical University from January 1 to December 31,2020,establish an observational study cohort,obtain clinical data of the patients,and stop the patients with analgesia and sedation every morning.The RASS score was given 1hour after the use of analgesic and sedative drugs.Patients with RASS score ≥-3 and patients who did not use analgesia and sedation were evaluated for delirium using CAM-ICU,and the CPOT score scale was used to evaluate the patient’s pain status and record the highest result of the day.Results: A total of 145 cases were included according to the inclusion and exclusion criteria,and 13 cases were excluded according to the exclusion criteria.Finally,132 cases were obtained,with a missing data rate of 9%;41(31%)cases of delirium occurred.There were 104 patients undergoing analgesia and sedation,of which 38(37%)patients developed delirium.According to the analysis of clinical data,age(OR=2.09),mechanical ventilation(OR=2.68),chronic obstructive pulmonary disease(OR=1.36),multiple organ dysfunction syndrome(OR=1.78),chronic renal failure(OR =1.13),acute kidney injury(OR=2.51),coronary atherosclerotic heart disease(OR=1.80),hypertension(OR=2.43),infection(OR=2.12),emergency(OR=1.33),town Pain sedation therapy(OR=4.79)is a risk factor for delirium,while diabetes(OR=0.91)and respiratory distress syndrome(OR=0.51)are not related to the occurrence of delirium.Further analysis of the differences between the various factors and delirium showed that age,acute physiology and chronic health scores,mechanical ventilation,acute kidney injury,hypertension,infection,analgesia and sedation were high risk factors for delirium(P<0.05).The differences between the types of analgesic and sedative drugs and delirium were tested.The results showed that sufentanil,sufentanil + midazolam,sufentanil + midazolam + propofol,and sufentanil were used alone.Tanyl +dexmedetomidine + midazolam + propofol,remifentanil + midazolam are all related to the occurrence of delirium,while remifentanil + dexmedetomidine,sufentanil +Dexmedetomidine,sufentanil+dexmedetomidine+propofol,and remifentanil have nothing to do with delirium.In the study of the relationship between the degree of analgesia and delirium,the CPOT pain score and the RASS sedation score were analyzed.The results showed that the RASS score was-2.03±1.17 in the delirium group and-1.30±1.19 in the non-delirium group.There was a statistical difference between the two groups.(P<0.05),indicating that the degree of sedation is related to the occurrence of delirium;CPOT pain score: 0.62±0.73 in the delirium group and 1.69±0.87 in the non-delirium group.There is a statistical difference between the two groups(P<0.05),indicating that the degree of analgesia is related to The occurrence of delirium is related.Conclusion: In summary,the incidence of delirium in critically ill patients is 31%,and the incidence of delirium in patients with analgesia and sedation is 37%.There are many factors that affect the occurrence of delirium,including age,acute physiology and chronic health scores,mechanical ventilation,acute kidney injury,hypertension,infection,analgesia and sedation are high risk factors for delirium.The type of analgesic and sedative drugs and the degree of analgesia and sedation are related to the occurrence of delirium.