CAM-ICU로 평가한 중환자실의 섬망 발생률과 섬망 발생 위험요인
Prevalence and Related Risk Factors of Delirium in Intensive Care Units as Detected by the CAM-ICU
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목적: 섬망 사정도구를 사용하여 섬망을 주기적으로 평가시 섬망을 발견율을 높일 수 있으나, 우리나라에서는 아직까지 규칙적으로 섬망을 사정한 결과에 대한 보고가 없다. 이에 본 연구는 중환자실에 환자를 돌보는 실무간호사에 의해 Confusion Assessment Method for the ICU (CAM-ICU)를 사용해서 섬망을 평가하였을 때 섬망 발생률과 관련 위험요인을 조사하고자 한다. 방법: 2013년 6월 10일부터 14일까지 서울소재 일 종합병원의 중환사실에 적어도 1일 이상 상주하였던 환자들의 의무기록을 후향적으로 조사하였다. 결과: 전체 대상자 중 125명의 환자에서 CAM-ICU 평가결과가 기록되어 있었다. 섬망 발생률은 27.2% 이었으며, 저활동형 섬망이 과활동형 섬망보다 높은 발생빈도를 보였다(61.8 vs. 38.2%). 섬망 발생은 고령, 고혈압 동반, 재원기간이 긴 경우, 인공호흡기 사용시, 보유하는 카테터가 많을수록, 혈중 단백질과 알부민 수치가 높을수록 흔한 것으로 나타났다. 섬망은 환자의 계통질환에 따라서도 차이를 보였다. 이 중 고령, 소화기계질환, 인공호흡기 사용이 섬망 발생의 유의한 위험요소인 것으로 나타났다. 결론: 규칙적인 섬망 사정은 저활동형 섬망을 조기 발견하는데 중요한 역할을 하는 것으로 나타났다. 섬망 발생 위험군을 규명하고 섬망을 예방하는 중재를 개발하여 적용한다면 중환자실의 섬망을 개선하는데 유용할 것으로 사료된다.
Abstract
Purpose: Screening of delirium using delirium assessment tools could promote delirium detection, however,there is lack of report about regular delirium assessment in Korea. This study was intended to describe theprevalence and related risk factors of delirium in intensive care unit (ICU). Methods: The Confusion AssessmentMethod for the ICU (CAM-ICU) data which were evaluated by nurses in ICUs was obtained through retrospectivechart review. Data were analyzed using descriptive statistics, Chi-square test, t-test, Mann-Whitney U test, andstepwise logistic regression. Results: Delirium was evaluated in 125 patients. The incidence rate of delirium was27.2% with a high prevalence of hypoactive delirium compared to hyperactive delirium (61.8 vs. 38.2%). Thosewith delirium were older, had hypertension, stayed longer in hospital, receiving ventilator support, had morenumber of catheters, had low serum protein and albumin level. Delirium incidence also varied according todiagnosis. Age, diagnosis of gastrointestinal disease, and application of ventilator were the significant risk factorsfor the incidence of delirium. Conclusion: Routine delirium screening is important for early detection ofdelirium. Identification of high-risk group and running delirium prevention programs could improve earlyrecognition of delirium in ICU.
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