摘要
目的探讨视频脑电图在老年ICU机械通气谵妄患者中的诊断价值,观察脑电爆发抑制特征。方法纳入2020-06—2022-06衡水市人民医院的98例老年ICU机械通气疑似谵妄患者,所有患者均给予连续性视频脑电图监测,以意识模糊评估法(CAM)评估结果为金标准,分析视频脑电图在老年ICU机械通气谵妄患者中的诊断价值,观察老年ICU机械通气谵妄患者脑电爆发抑制特征,对比谵妄、非谵妄患者基线资料,分析影响谵妄发生的相关因素。结果CAM评估结果显示,98例老年ICU机械通气疑似谵妄患者中发生谵妄76例(77.55%),非谵妄22例(22.45%)。以CAM评估结果为金标准,视频脑电图诊断老年ICU机械通气患者谵妄的灵敏度、特异度、准确度分别为89.47%(68/76)、81.82%(18/22)、87.76%(86/98)。谵妄患者视频脑电图爆发抑制发生率明显高于非谵妄患者(χ^(2)=37.473,P<0.05),爆发抑制期的主要症状为睡眠-觉醒障碍、构建能力障碍、行为变化出现速度快,清醒期以意识水平、语言清晰度、注意力恢复最好。Logistic回归分析显示,机械通气时间、镇静药物使用是老年ICU机械通气患者发生谵妄的危险因素(OR>1,P<0.05)。结论视频脑电图在老年ICU机械通气谵妄患者中具有一定诊断价值,视频脑电图爆发抑制期以睡眠-觉醒障碍、构建能力障碍、行为变化出现速度快为主要特征,可能是谵妄发生的预警。
Objective To explore the diagnostic value of video-electroencephalogram in aged patients with mechanical ventilation delirium in intensive care unit(ICU),and observe the characteristics of electroencephalogram burst inhibition.Methods A total of 98 cases of suspected delirium induced by mechanical ventilation in the elderly ICU were included from June 2020 to June 2022.All patients were given continuous video-electroencephalogram monitoring.With the confusion assessment method(CAM)scale as the gold standard,the diagnostic value of video-electroencephalogram in the elderly ICU patients with mechanical ventilation delirium was analyzed,and the electroencephalogram burst inhibition characteristics of the elderly ICU patients with mechanical ventilation delirium were observed.The baseline data of delirium patients and non-delirium patients were compared,and the related factors that affect the occurrence of delirium were andyzed.Results The results evaluated by CAM showed that among the 98 elderly ICU mechanical ventilation suspected delirium patients,76 cases(77.55%)experienced delirium,and 22 cases(22.45%)experienced non-delirium.Based on the results of CAM evaluation as the gold standard,the sensitivity,specificity and accuracy of video-electroencephalogram in the diagnosis of delirium in elderly ICU patients undergoing mechanical ventilation were 89.47%(68/76),81.82%(18/22)and 87.76%(86/98),respectively,indicating that it had certain diagnostic value.The incidence of burst inhibition by video-EEG in delirium patients was significantly higher than that in non-delirium patients(χ^(2)=37.473,P<0.05).The main symptoms in the outbreak inhibition period were sleep-waking disorder,building ability disorder,and rapid behavior change.In the awake period,the consciousness level,language clarity,and attention were restored best.Logistic regression analysis showed that mechanical ventilation time and sedative drugs were the risk factors for delirium in elderly ICU patients undergoing mechanical ventilation(OR>1,P<0.05).Conclusion Video-electroencephalogram has certain diagnostic value in elderly patients with mechanical ventilation delirium in ICU.The main characteristics of video-electroencephalogram in burst inhibition stage are sleep-waking disorder,structural ability disorder and rapid behavior change,which may be the early warning of delirium.
作者
黄景妹
汤双榕
王玉占
高晓峰
马珍
HUANG Jingmei;TANG Shuangrong;WANG Yuzhan;GAO Xiaofeng;MA Zhen(Hengshui People’s Hospital/Halieson International Peace Hospital,Hengshui 053000,China)
出处
《中国实用神经疾病杂志》
2023年第12期1542-1547,共6页
Chinese Journal of Practical Nervous Diseases
基金
河北医学科学课题计划项目(编号:20220469)。
关键词
谵妄
老年人
视频脑电图
爆发抑制
机械通气
神经重症监护
诊断价值
Delirium
The elderly
Video-electroencephalogram
Outbreak suppression
Mechanical ventila⁃tion
Neurological intensive care
Diagnosis value
