Risk factors for intensive care unit delirium after cardiac operation / 中华危重病急救医学

Objective? ?To?analyze?the?risk?factors?of?delirium?in?patients?in?cardiac?surgery?intensive?care?unit?(CSICU).? Methods? A?prospective?observational?study?was?performed.?Patients?admitted?to?CSICU?of?Fujian?Medical?University?Union?Hospital?from?March?to?August?in?2017?were?enrolled.?The?combination?of?the?Richmond?agitation?sedation?scale?(RASS)?and?the?ICU-confusion?assessment?method?(CAM-ICU)?were?used?to?evaluate?delirium.?The?patient?was?assessed?on?the?second?day?after?CSICU?admission,?twice?a?day,?the?evaluation?was?stopped,?and?the?follow-up??observation?was?terminated?after?the?patient?was?discharged?from?CSICU.?The?patients?were?divided?into?two?groups?according?to?whether?delirium?occurred?in?CSICU.?The?general?and?clinical?treatment?data?(including?condition,?operation,?anesthesia?and?CSICU?treatment)?of?the?two?groups?were?compared.?The?related?factors?of?delirium?were?identified?by?univariate?analysis?and?multifactor?Logistic?regression?analysis.? Results? A?total?of?318?cases?were?included?in?this?study.?Among?them,?93?cases?had?delirium?and?the?incidence?of?delirium?was?29.2%.?It?was?shown?by?univariate?analysis?that?age,?history?of?hypertension,?type?of?surgery,?surgical?procedure,?American?Society?of?Anesthesiologists?(ASA)?anesthesia?classification,?usage?of?propofol,?plasma?transfusion,?red?blood?cells,?platelet?transfusion,?blood?loss,?operative?time,?cardiopulmonary?bypass?(CPB)?time,?myocardial?block?time,?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHEⅡ),?duration?of?mechanical?ventilation,?the?length?of?intensive?care?unit?(ICU)?stay,?postoperative?usage?of?diazepam,?midazolam,?fentanyl,?morphine,?chlorpromazine,?etc.?which?were?related?to?delirium,?and?occupation?? (on-the-job?or?self-employed),?medical?insurance?(city?or?provincial?medical?insurance),?education?(primary?to?junior?high?school,?high?school?or?above)?could?reduce?the?risk?of?delirium.?Colinearity?diagnosis?was?performed?on?variables?with?statistically?significant?differences,?and?variables?with?variance?expansion?factor?(VIF)?<?3?were?included?in?multivariate?Logistic?regression?analysis.?The?results?showed?that?age,?education?level,?type?of?surgery,?ASA?classification,?CPB?time,?APACHEⅡ,?ICU?mechanical?ventilation?time,?and?post?operation?usage?of?midazolam?were?independently?related?to?delirium?[age:?odds?ratio?(OR)?=?1.625,?95%?confidence?interval?(95%CI)?=?1.303-2.026;?education?level:?OR?=?0.293,?95%CI =?0.171-0.504;?type?of?surgery:?OR?=?2.194,?95%CI =?1.052-4.576;?ASA?classification:?OR?=?1.916,?95%CI =?1.032-3.559;?CPB?time:?OR =?2.125,?95%CI =?1.105-4.088;?APACHEⅡ:?OR =?2.091,?95%CI =?1.005-4.349;?ICU?mechanical?ventilation?time:?OR =?1.943,?95%CI?=?1.269-2.975;?midazolam:?OR =?2.653,?95%CI =?1.328-5.299;?all?P?<?0.05],?among?which,?high?education?level?has?a?good?protective?effect?on?delirium.? Conclusions? Age,?type?of?surgery,?ASA?classification,?CPB?time,?APACHEⅡ,?ICU?mechanical?ventilation?time,?post?operation?usage?of?midazolam?were?independent?risk?factors?for?delirium,?and?high?education?level?had?a?good?protective?effect.?Among?them,?the?educational?level,?CPB?time,?duration?of?mechanical?ventilation,?and?midazolam?are?intervention?factors.?In?clinical?treatment,?not?only?the?risk?factors?should?be?identified,?but?also?intervention?should?be?taken?to?prevent?the?occurrence?of?delirium.

Reliability and validity of Chinese version of Intensive Care Unit Environment Stressor Questionnaire / 中华护理杂志

Objective To translate the English vcrsion of Intensive Care Unit Environment Stressor Questionnaire (ESQ) into Chinese,and test the reliability and validity of the Chinese version of Intensive Care Unit Environment Stressor Questionnaire (ESQ-C).Methods The ESQ-C was translated from the ESQ and back-translated,Delphi tcchnique was used to conduct cultural adaption.The reliability and validity of ESQ-C were tested in 313 cardiac surgery ICU patients.Results The ESQ-C contained 42 items.Eight factors that explained 51.803％ of the variance were extracted after exploratory factor analysis.The Cronbach's α coefficient of the questionnaire was 0.851,the odd-even split-half reliability was 0.888.Conclusion ESQ-C was proved to be valid and reliable.It's a valuablc tool to assess the environment stressors of ICU patients in China.