严重病情的成年人疼痛和妄想之间的关系
Ting Ting Wu1,2, Lisette M Vernooij3,4,5, Matthew S Duprey6
1Bouve College of Health Sciences, Northeastern University, Boston, MA.
Critical care explorations
|December 6, 2023
概括
这项研究发现,重症监护室 (ICU) 的疼痛可能不是 Delirium 的直接风险因素. 即使是中度至严重的疼痛,从没有妄想的清醒过渡到妄想并没有显著的关联.
科学领域:
- 关键护理医学 关键护理医学
- 神经科学是一个神经科学.
- 疼痛管理 疼痛管理
背景情况:
- 阿片类药物通常用于ICU的疼痛,但也是一种已知的 Delirium 的风险因素.
- 疼痛本身与重症患者妄的发展之间的直接关联仍然不清楚.
研究的目的:
- 为了研究ICU患者经历的疼痛严重程度与随后的 Delirium 发展之间的关系.
- 为了确定疼痛是否独立于阿片类药物使用,是ICU Delirium的危险因素.
主要方法:
- 一项前性队列研究是在一个32个床位的学术医疗外科ICU中进行的.
- 住院至少24小时的重病成年人 (n = 4,064) 用数值评分表 (NRS) 或临床护理疼痛观察工具 (CPOT) 评估疼痛,以及心理状态 (妄想,无法唤醒或没有妄想的清醒).
- 统计分析,包括通过链式方程的多重推算和一级马尔科夫模型,对已知的妄想风险因素和竞争风险进行控制.
主要成果:
- Delirium 在 14,013 ICU 日中的 19.6% 发生.
- 任何疼痛 (轻度,中度或严重) 的存在与从没有妄想的清醒过渡到妄想的过渡没有显著关联 (调整的几率比率[aOR],0.96;95% CI,0.76-1.21).
- 这些发现即使在单独考虑疼痛严重程度类别和每日阿片类药物剂量控制后也保持一致.
结论:
- 在ICU中的疼痛,考虑到其他风险因素,如阿片类药物使用,似乎不是发展妄想的重要风险因素.
- 需要进一步的前性研究,以确定ICU痴呆症中疼痛的作用.
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