谵妄介导重症缺血性脑卒中患者跌倒史与短期死亡风险之间的关系

IF 1.7 4区 医学 Q2 NURSING
Clinical Nursing Research Pub Date : 2024-09-01 Epub Date: 2024-08-26 DOI:10.1177/10547738241273164
Hongtao Cheng, Xiaozhen Xu, Yonglan Tang, Xin Yang, Yitong Ling, Shanyuan Tan, Zichen Wang, Wai-Kit Ming, Jun Lyu
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引用次数: 0

摘要

缺血性脑卒中患者跌倒的倾向性增加,导致严重的身心痛苦。本研究调查了 2008 年至 2019 年期间 2950 名确诊为缺血性中风的 ICU 成年患者在入住重症监护病房(ICU)前 3 个月内跌倒与 28 天内死亡率之间的关系,重点研究了谵妄的潜在中介作用。主要结果是短期死亡率(28 天、60 天和 90 天)和谵妄风险。每位患者都接受了至少一年的随访。谵妄主要通过重症监护室意识混乱评估法和查看护理记录进行评估。使用 Wilcoxon 秩和检验或卡方检验比较有跌倒史和无跌倒史患者的组间差异。采用 Cox 比例风险或逻辑回归模型探讨跌倒史与结果之间的关系,并进行因果中介分析。结果显示,有近期跌倒史的患者28天(危险比[HR]:1.62,95%置信区间[CI]:1.35-1.94)、60天(HR:1.67,95%置信区间[CI]:1.42-1.98)和90天死亡率(HR:1.66,95%置信区间[CI]:1.41-1.95)风险显著增加,谵妄风险也显著增加(几率比:2.00,95%置信区间[CI]:1.66-2.42)。谵妄明显介导了跌倒史与 28 天死亡率之间的关系(总效应:HR:1.77,95% CI:1.45-2.16;自然间接效应:HR:1.12,95% CI:1.05-1.21;介导比例:24.6%):24.6%).这些研究结果表明,近期跌倒过的缺血性中风患者短期死亡风险增加,部分原因是谵妄。旨在预防谵妄的策略可能会改善这类患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delirium Mediated the Association Between a History of Falls and Short-Term Mortality Risk in Critically Ill Ischemic Stroke Patients.

Patients with ischemic stroke have an increased propensity to fall, resulting in significant physical and psychological distress. This study examined the association between falls in the 3 months prior to intensive care unit (ICU) admission and mortality within 28 days among 2950 adult ICU patients diagnosed with ischemic stroke from 2008 to 2019, focusing on the potential mediating role of delirium. The primary outcomes were short-term mortality (28, 60, and 90 days) and the risk of delirium. Each patient was followed for at least 1 year. Delirium was primarily assessed using the Confusion Assessment Method for the ICU and by reviewing nursing notes. Group differences between patients with and without a history of falls were compared using the Wilcoxon rank-sum test or the chi-squared test. Cox proportional risk or logistic regression models were used to explore the association between fall history and outcomes, and causal mediation analysis was performed. Results showed that patients with a recent fall history had a significantly increased risk of 28-day (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.35-1.94), 60-day (HR: 1.67, 95% CI: 1.42-1.98), and 90-day mortality (HR: 1.66, 95% CI: 1.41-1.95), as well as an increased risk of delirium (odds ratio: 2.00, 95% CI: 1.66-2.42). Delirium significantly mediated the association between fall history and 28-day mortality (total effect: HR: 1.77, 95% CI: 1.45-2.16; natural indirect effect: HR: 1.12, 95% CI: 1.05-1.21; proportion mediated: 24.6%). These findings suggest that ischemic stroke patients with a recent fall have an increased risk of short-term mortality, partly mediated by delirium. Strategies aimed at preventing delirium may potentially improve prognosis in this patient population.

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来源期刊
CiteScore
3.40
自引率
5.90%
发文量
107
审稿时长
>12 weeks
期刊介绍: Clinical Nursing Research (CNR) is a peer-reviewed quarterly journal that addresses issues of clinical research that are meaningful to practicing nurses, providing an international forum to encourage discussion among clinical practitioners, enhance clinical practice by pinpointing potential clinical applications of the latest scholarly research, and disseminate research findings of particular interest to practicing nurses. This journal is a member of the Committee on Publication Ethics (COPE).
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