探讨重症监护评分与脓毒症相关性脑病诊断及预后的意义李敏雄柯媛媛伍增龙马俊广东省佛山市高明区人民医院重症监护科广东佛山528500【摘要】目的：评估ICU意识状态评分(CAM-ICU)对脓毒症相关性脑病(SAE)的诊断作用，及其与SAE预后的关系。方法：选取入住ICU超过24h的脓毒症患者，1d2次进行CAM-ICU评分。根据CAM-ICU评分，将患者分为SAE组和无SAE组，观察2组患者的临床特征、平均住院Id、住院期间死亡率。结果：共入选56例脓毒症患者，根据CAM-ICU评分，15例(26.8%)患者被诊断为SAE,SAE患者年龄大于非SAE患者，为(64.2±7.1)岁VS(56.6±6.5)岁，P<0.001;使用镇静药及抗精祌病药的比例高于非SAE者(分别为60%VS24.4%,P=0.01；40°/OVS7.3°/O,P=0.01)O但2组性别、APACHEII评分、机械通气使用率无统计学差异(P>0.05)。SAE组平均住院日及住院期间死亡率均高于非SAE组，分别为(15.9±9.1)VS(11.2±7.4),P=0.03;33.3%VS4.9%,P=0.02。采用生存曲线分析显示，SAE组的预后差于非SAE组(x2=9.621,P=0.002)。结论：CAM-ICU评分有助于对SAE患者的诊断，高龄、使用镇静药、抗精祌病药可能会增加SAE的风险，SAE患者预后相对非SAE患者差。【关键词】意识状态评分；脓毒症相关性脑病；脓毒症；预后【中图分类号】R714.62+6【文献标识码】B【文章编号】16744999(2015)9-0689-02EvaluationofCAM-ICUforthedetectionofSepsis-AssociatedEncephalopathyinsepsispatientsfocusingonrelevantclinicaloutcomesLiMinxiong,KeYuanyuan'WuZenglong,MaJun(IntensiveCareUnit,GaomingPeople’sHospital,Foshan,Guangdong,528500,China)[Abstract]Purpose:ToassessthevalueinthediagnosisofSepsis-AssociatedEncephalopathy(SAE)obtainedbytheConfusionAssessmentMethodfortheICU(CAM-ICU)andtheassociationwithoutcomes.Methods:SepsispatientsadmittedtotheICUformorethan24hourswereincluded.AllthepatientswereevaluatedtwiceadaybytheCAM-ICU,andweredividedintoSAEgroupandnon-SAEgroup.Clinicalfeatures,lengthofhospitalstayandhospitalmortalitywerecomparedbetweenthetwogroups.Results:Duringthestudyperiod,56patientswereevaluated,SAEwasidentifiedin26.8%ofpatientsbyCAM-ICU.PatientswithadiagnosisofSAEwereolder(64.2±7.1VS56.6±6.5,P<0.001).FrequencyofSAEwashigherinpatientsreceivingsedativesandantipsychotics(60%VS24.4%,P=0.01;40%VS7.3%,P=0.01).NosignificantdifferencesbetweenthosewithandwithoutSAEregardingsex,AcutePhysiologyandChronicHealthEvaluation(APACHE)II,orfrequencyofmechanicalventilationwereobserved.SAEwasassociatedwithbothsignificantlyincreaselengthofhospitalstay(15.9±9.1VS11.2±7.4,P=0.03)andmortalityinthehospital(33.3%VS4.9%,P=0.02).MortalityratesestimatedwithKaplan-MeiercurvesinSAEgroupwerehigherthanthoseinnon-SAEgroup(x2=9.621，P=0.002).Conclusions:TheCAM-ICUmayusedtoidentifypatientswithSAE.Oldage,theuseofsedativedrugsorantipsychoticsmayincreasetheincidenceofSAE.TheprognosisofSAEpatientsgetworsethanthatofnon-SAEpatients.【keywords】ConfusionAssessmentMethod;Sepsis-AssociatedEncephalopathy;sepsis;prognosis脓毒症相关性脑病(sepsis-associatedencephalopathy,SAE)是指由全身炎症反应或脓毒症(sepsis)引起的弥散性脑功能障碍，往往SAE越严重，患者病死率也越高[1】。由于SAE临床表现缺乏特异性，常被漏诊。S前认为，对于ICU的患者使用意识状态评估(ConfusionAssessmentmethodfortheIntensiveCareUnit,CAM-ICU)，对谵妄的诊断有较好的敏感性(93%)和特异性(89%)[2],但较少有研究评估CAM-ICU在SAE中的诊断价值及其与SAE预后的关系。本研究拟在这一方面进行深入探讨，报告如下。1资料与方法1.1一般资料选取2011年1月-2014年5月在我院ICU住院的脓毒血症患者(排除入住ICU吋间未超过24h及入院吋昏迷者)56例，其中男31例、女25例，年龄39〜70(61.8±7.8)...
