| 摘要: | 研究目的：
一、比較計畫性與非計畫性入住加護病房的外科病人之基本屬性、疾病狀態及譫妄發生率之差異。
二、探討計畫性與非計畫性入住加護病房的外科病人譫妄發生的風險比 （hazard ratio, HR）。
三、比較計畫性與非計畫性入住加護病房的外科病人譫妄發生影響因素。
研究方法：
本研究透過病歷回溯研究法，以電子病歷回溯收集 2019-2020年入住北部某醫學中心加護病房之外科病人資料進行分析。研究變項包括：人口學特性、疾病資料、計畫性與非計畫性入住加護病房及有無發生譫妄進行分析，以卡方檢定、單因子變異數分析和邏輯斯迴歸推論統計方式進行各項分析，以存活分析比較兩組發生譫妄的風險比值。
結果：
本研究共納入934名樣本，對非計畫組與計畫組進行1:1傾向分數配對後分析，一、非計畫組入住加護病房的外科病人譫妄發生率12.3%顯著高於計畫組的6.6%（p=.046）。二、非計畫性入ICU組的風險比 (hazard ratio, HR)是計畫組的4.45倍。三、計畫組與非計畫組兩組譫妄發生風險與「年齡」、「意識評估」、「約束」及「APACHE分數」四項共同相關因子。不同處-計畫組譫妄影響因素「侵入性管路數」達統計上的顯著（p= .02），非計畫組譫妄影響因素「腎臟病」、「心臟病」達統計上的顯著（p= .005；p= .01）。
結論：
本研究貢獻為提供醫護人員參考，使其了解外科病人入住ICU的譫妄發生風險，如有年齡大於65歲、患有多重疾病（合併腎臟病、心臟病）、意識評估混亂、有進行約束、非計畫性入住ICU、疾病嚴重度高等危險因子。建議臨床醫護人員謹慎評估病人意識、情緒、壓力累積之變化，適時關心病人轉移注意力，及早使用介入性組合式照護措施，以預防或降低病人譫妄發生導致身心傷害及併發症產生。
Objective:
1. Compare the differences in basic attributes, disease status, and incidence of delirium between planned and unplanned surgical patients admitted to the intensive care unit. 2. To explore the hazard ratio (HR) of delirium in surgical patients with planned and unplanned admission to the intensive care unit. 3. To compare the factors influencing the occurrence of delirium in surgical patients with planned and unplanned admission to the intensive care unit.
Methods:
This study uses the medical record retrospective research method to collect and analyze the data of surgical patients admitted to the intensive care unit of a northern medical center from 2019 to 2020 using electronic medical records. The study variables include: demographic characteristics, disease data, planned and unplanned admission to the intensive care unit, and the occurrence of delirium. Analysis was performed using chi-square test, single-factor analysis of variance and logistic regression inference statistics. For each analysis, survival analysis was used to compare the risk ratio of delirium between the two groups.
Results:
A total of 934 samples were included in this study, and a 1:1 propensity score matching analysis was conducted between the unplanned group and the plan group: 1. The incidence of delirium among surgical patients admitted to the intensive care unit in the unplanned group was 12.3%, which was significantly higher than the 6.6% rate in the planned group (p=.046). 2. The hazard ratio (HR) of the unplanned ICU admission group was 4.45 times that of the planned group. 3. The risk of delirium in the planned group and the unplanned group is related to four common correlation factors: "age", "consciousness assessment", "restraint" and "APACHE score". The difference - the factor "number of invasive tubes" that affects delirium in the planned group is statistically significant (p= .02), and the factors that influence delirium in the unplanned group "kidney disease" and "heart disease" are statistically significant (p = .005; p = .01).
Conclusion:
The study is to provide a reference for medical staff to understand the risk of delirium in surgical patients admitted to the ICU, such as those who are older than 65 years old, suffer from multiple diseases (combined with kidney disease and heart disease), confused consciousness assessment, restraint, unplanned admission to ICU, high disease severity and other risk factors. It is recommended that clinical medical staff carefully evaluate changes in patients' consciousness, emotions, and accumulated stress, pay attention to the patient's attention in a timely manner, and use interventional combined care measures as early as possible to prevent or reduce the occurrence of physical and mental harm and complications caused by delirium in patients. |
