危重患者肥胖、营养状况与死亡率的关系

M. Robinson, K. Morgensen, J. Casey, C. McKane, Takuhiro Moromizato, J. Rawn, K. Christopher
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引用次数: 3

摘要

谵妄发展的危险因素。过去对许多风险因素进行了研究,结果相互矛盾。因此,本研究的作者自行对已证实的风险因素的文献进行了系统的回顾。他们找到了33篇研究重症监护室谵妄的文章,这些文章要么是在患者队列中,要么是在随机对照试验中。研究人员对这些研究的结果进行了评估,以确定在单因素或多因素分析中发现的谵妄的危险因素。多变量分析反复显示与谵妄相关的危险因素被认为是最重要的因素,应该在未来的谵妄试验中进行评估。大多数与谵妄密切相关的危险因素无法改变,包括以下因素:年龄、痴呆、高血压、病情加重、昏迷、急诊手术、机械通气和多发创伤。导致谵妄的唯一可改变的变量是代谢性酸中毒和前一天的谵妄。右美托咪定被发现可以防止谵妄。虽然这是一项重要的研究,但数据不能用于修改治疗方法。为了预防谵妄,我们必须更好地了解它的发展,从而找到预防它的方法。虽然危险因素的列表似乎很广泛,但环境条件在ICU谵妄发展中的作用尚未得到充分研究。在ICU外,谵妄可以通过反复引导患者、减少噪音、使用助听器和眼镜、早期活动和改善睡眠模式来预防。所有这些因素都可能在重症监护患者谵妄中起重要作用。目前,我们对谵妄的研究仍然局限于描述性的,而不是分析性的。为了更好地研究和控制谵妄,我们必须更好地了解谵妄的生物学过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Relationship Among Obesity, Nutritional Status, and Mortality in the Critically Ill
risk factors for the development of delirium. Numerous risk factors have been studied in the past, with conflicting results. Therefore, the authors of the current study took upon themselves to conduct a systematic review of the literature for proven risk factors. They found 33 articles that studied delirium in the ICU either in patient cohorts or in randomized controlled trials. The investigators evaluated the results of these studies to locate risk factors for delirium that were found in either univariate or multivariate analysis. Risk factors that were repeatedly shown by multivariate analysis to be associated with delirium are suggested to be the most important ones and should be evaluated in any future trial of delirium. Most of the risk factors having a strong association with delirium cannot be modified and include the following: age, dementia, hypertension, worse severity of illness, coma, emergency surgery, mechanical ventilation, and polytrauma. The only modifiable variables that predispose to delirium are metabolic acidosis and delirium during the previous day. Dexmedetomidine was found to protect against delirium. Although this is an important study, the data cannot be used to modify treatment. In order to prevent delirium, we have to better understand its development and thus find ways to prevent it. Although the list of risk factors appears extensive, the role of environmental conditions in the development of delirium in the ICU has not been sufficiently studied. Outside the ICU, delirium could be prevented by repeated orientation of the patients, reduction of noise, use of hearing aids and glasses, early mobilization, and better sleep patterns. All of these factors may play an important role in delirium in critical care patients. Our research into delirium at present is still limited to the descriptive and not to the analytical. We have to better understand the biological process of delirium in order to better study and control it.
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