重症监护病房重症脓毒症患者远期负性情绪发生率及相关因素分析

Incidence and associated determinants of long-term negative emotions in intensive care unit (ICU) patients suffering from severe sepsis

摘要:

目的 探讨重症监护病房（ICU）重症脓毒症患者远期负性情绪发生率及相关因素。方法 选取2019年1月—2020年12月南阳市第一人民医院入住ICU的99例重症脓毒症患者作为研究对象，均随访2年。将并发焦虑抑郁的患者作为负性情绪组，未并发焦虑抑郁的患者作为非负性情绪组，分别有30和69例。分析两组患者年龄、性别、种族、体重、入院临床特征（住院时长、ICU时长及血清乳酸、降钙素、C反应蛋白水平）、入院诊断疾病（心血管系统、呼吸系统、传染病、其他）、疾病严重程度［急性生理学和慢性健康评估Ⅱ（APACHE Ⅱ）评分、脓毒症相关器官衰竭评估（SOFA）评分、感染性休克］、器官支持情况［机械通气、连续性肾脏替代疗法（CRRTn）］、入住ICU前72 h是否使用皮质类固醇及在ICU住院期间咪达唑仑、芬太尼、多巴酚丁胺、去甲肾上腺素和氟哌啶醇的累积剂量等基线特征。结果 两组患者性别构成、年龄、种族、体重、心血管系统疾病、呼吸系统疾病、传染病、其他疾病、APACHE Ⅱ评分、SOFA评分、机械通气、CRRTn、入住ICU前72 h使用皮质类固醇、咪达唑仑、多巴酚丁胺、去甲肾上腺素的累积剂量比较，差异均无统计学意义（P >0.05），两组患者的住院时长、ICU时长、乳酸、降钙原素、血清C反应蛋白水平、感染性休克、芬太尼、氟哌啶醇比较，差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示：ICU时长［O^R=0.167（95% CI： 0.125，0.616）］、氟哌啶醇［O^R=3.031（95% CI： 1.093，5.830）］是ICU重症脓毒症患者远期负性情绪的危险因素（P <0.05）。结论 ICU重症脓毒症患者远期负性情绪具有一定的发生率，对具有ICU时长过长及氟哌啶醇累积用量过低的患者应格外关注远期负性情绪的复发，并做好预防工作。

Abstract:

Objective To analyze the incidence and associated determinants of long-term negative emotions in ICU patients with severe sepsis.Methods Nity-nine patients with severe sepsis admitted to our ICU from January 2019 to December 2020 were selected and followed up for 2 years. Patients developing anxiety and depression were included in the negative emotion group, while those without anxiety and depression were included in the non-negative emotion group, with 30 and 69 cases in each group, respectively. The baseline characteristics, including age, gender, ethnicity, weight, clinical features during hospitalization (length of hospital stay, length of ICU stay, and serum levels of lactate, procalcitonin, and C-reactive protein), diagnoses at admission (cardiovascular, respiratory, infectious and other diseases), severity of the disease [acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, and septic shock], usage of corticosteroids 72 hours before organ support (mechanical ventilation, CRRTn), and cumulative doses of midazolam, fentanyl, dobutamine, norepinephrine, and haloperidol during ICU stay, were analyzed.Results There was no difference in gender composition, age, ethnicity, weight, frequency of cardiovascular, respiratory, infectious and other diseases, APACHE II score, SOFA score, usage of corticosteroids 72 hours before mechanical ventilation and CRRTn, or cumulative doses of midazolam, dobutamine, and norepinephrine between the two groups of patients (P > 0.05). There were significant differences in the length of hospital stay, length of ICU stay, serum levels of lactate, procalcitonin, and C-reactive protein, incidence of septic shock, and cumulative doses of fentanyl and haloperidol between the two groups of patients (P < 0.05). Multivariable Logistic regression analysis revealed that the length of ICU stay [O^R =0.167 （95% CI: 0.125, 0.616）] and the cumulative dosage of haloperidol [O^R = 3.031, (95% CI: 1.093, 5.830) ] were two risk factors for long-term negative emotions in ICU patients with severe sepsis (P < 0.05).Conclusions ICU patients with severe sepsis are likely to suffer from long-term negative emotions. Among them, those with prolonged length of ICU stay and low cumulative dosage of haloperidol should be paid special attention to and preventive measures should be taken concerning the recurrence of long-term negative emotions.