创伤性脑损伤患者谵妄发生的预测因素及预防干预策略-现代医学

创伤性脑损伤患者谵妄发生的预测因素及预防干预策略

单位：1. 淮安市第二人民医院急诊医学科, 江苏淮安 223001;
2. 淮安市第二人民医院中心手术室, 江苏淮安 223001

分类号：R651.15

出版年·卷·期（页码）：2025·53·第八期（1278-1283）

摘要：

目的：探究创伤性脑损伤患者谵妄发生的预测因素，提出预防干预策略。方法: 回顾性分析2023年6月至2025年1月于我院接受治疗的216例创伤性脑损伤患者临床资料，依据住院期间是否发生谵妄分为谵妄组与非谵妄组。比较两组临床资料，采用Logistic回归分析创伤性脑损伤患者发生谵妄的影响因素，构建回归预测模型并对模型进行验证及效能评价。结果：216例创伤性脑损伤患者中有57例发生谵妄，发生率为26.39%。两组患者在年龄、吸烟史、白细胞介素-6(IL-6)水平、血清白蛋白水平、血清钾水平、神经检查频率、入院损伤严重程度评分(ISS)、脑室内出血等方面，差异有统计学意义(P＜0.05)。Logistic回归分析显示，IL-6、入院ISS≥20分、脑室内出血为创伤性脑损伤病人发生谵妄的独立危险因素，每4 h神经检查为保护因素(P＜0.05)。依据上述独立影响因素建立回归预测模型，受试者工作特征(ROC)曲线预测模型对创伤性脑损伤患者发生谵妄的预测曲线下面积(AUC)为0.929，预测敏感度、特异度分别为82.46%、89.31%。H-L检验提示预测模型一致性良好(P＞0.05)。结论：创伤性脑损伤病人发生谵妄概率仍较高，IL-6、入院ISS、脑室内出血、神经检查频率是其重要影响因素，临床可据此制定预防干预策略，以降低谵妄发生率。

Objective: To investigate predictive factors for delirium in patients with traumatic brain injury(TBI) and propose preventive intervention strategies. Methods: Clinical data of 216 TBI patients treated at our hospital from June 2023 to January 2025 were retrospectively analyzed. Patients were divided into delirium and non-delirium groups based on the occurrence of delirium during hospitalization. Clinical data were compared between the groups. Logistic regression analysis was used to identify factors influencing delirium occurrence in TBI patients,and a regression prediction model was constructed,validated and evaluated for performance. Results: Among 216 TBI patients,57 developed delirium,with an incidence of 26.39%. Statistically significant differences were found between the two groups in age,smoking history,interleukin-6(IL-6) levels,serum albumin levels,serum potassium levels,neurological check frequency,admission Injury Severity Score(ISS),and intraventricular hemorrhage(P<0.05). Logistic regression analysis showed that IL-6,admission ISS≥20,and intraventricular hemorrhage were independent risk factors for delirium in TBI patients,while 4-hourly neurological checks served as a protective factor(P<0.05). A regression prediction model was established based on these independent factors. The receiver operating characteristic(ROC) curve showed an area under the curve(AUC) of 0.929 for predicting delirium,with sensitivity and specificity of 82.46% and 89.31%,respectively. The Hosmer-Lemeshow test indicated that the model had a good consistency(P>0.05). Conclusion: The incidence of delirium remains high in TBI patients. IL-6,admission ISS,intraventricular hemorrhage,and neurological check frequency are significant influencing factors. Clinical preventive intervention strategies can be developed based on these factors to reduce delirium occurrence.

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