[[alternative]]The Effect of an Intensive Care Unit Patients with Delirium Occurred in Health Status, Medical Treatment Related to the Disease State: a Teaching Hospital in Southern Taiwan

[[abstract]]背景：瞻妄為一種急性腦部功能障礙，更是老年人住院經常發生的問題。研究顯示其中又以加護病房的老人瞻妄發生率最高，可達70〜87%。但是過去國內針對加護單位急性瞻妄的影響因素之研究，多數研究不但排除接受呼吸器醫療照顧處置的個案，同時對疾病因素與用藥因素的作用，也缺乏深入的探討。研究目的：探討影響加護病房病人發生瞻妄的危險因素和影響瞻妄嚴重程度的預測因子及透過Cox比例危險模式，探討入住加護病房期間內瞻妄發生的存活分析。方法：本研究為採前瞻式觀察性研究，方便取樣方式，以結構式問卷於台南地區一所地區教學醫院的兩個加護病房進行資料收集，共收案160位。研究工具包含疾病嚴重度(APACHE II)、加護病房混亂評估表(CAM-ICU)、鎮靜程度評分表(RASS)、以及瞻妄嚴重程度評分表(DI)。資料統計經SPSS-20版套裝統計軟體，以描述性統計、(獨立)雙樣本平均數差異t檢定、卡方檢定、羅吉斯迴歸分析以及多元線性迴歸分析、Cox比例危險模式進行資料分析。結果：本研究發現研究對象的瞻妄發生率為14.1﹪；瞻妄發生的型態以低活動型為最多90.9%。影響研究對象的瞻妄發生危險因素分別為：生理數值的『高血糖』變項(2=9.71，p<.05)、『代謝性酸中毒』變項(2=53.59，p<.001)以及疾病狀態的『合併症的多寡』(t=2.94，p<0.01)、『加護病房停留天數』(t=-2.45，p<.05)、『通知轉普通病房時待床天數』(t=2.23，p<.05)；追蹤研究對象一段時間後，得知影響瞻妄發生的重要預測因素為：『代謝性酸中毒』OR值(Odds ratio)為25.50(p<.001)以及『加護病房停留天數』的OR值為1.52(p<.01)。再則，可預測瞻妄嚴重程度分數越高為：年齡越大(t=2.184，p<.05)、罹患風濕性關節炎(t=3.127，p<.01)、高血糖(t=-2.791，p<.01)、代謝性酸中毒(t=2.999，p<.01)、過去疾病史的多寡(t=2.504，p<.05)、呼吸器天數(t=2.366，p<.05)。另外，針對加護病房病人瞻妄發生事件進行存活分析，在控制了年齡與性別後發現，代謝性酸中毒組發生瞻妄的風險是無代謝性酸中毒的12.82倍(p<.001)。結論：透過結果可得知加護病房病人瞻妄及其瞻妄嚴重程度的危險因素、重要預測因子以及個體健康狀態對瞻妄發生的存活風險，未來宜針對相關因素給予適當的評估、防範、追蹤以期能正確診斷並減少瞻妄的發生，以減少病人不必要的傷害。關鍵字：瞻妄發生、加護病房、危險因子、存活分析[[abstract]]Background：Delirium is an acute neural dysfunction that often occurs among hospitalized elders. Studies have indicated that the highest rate of (70 to 87 %) delirium occurs among elders in the intensive care unit (ICU). However, most Taiwanese researches targeting delirium in the ICU have excluded subjects who received respirator therapies. Furthermore, factors such as disease and medication effects were also rearly investigated. Purpose：To investigate the risk factors of delirium and the predicting factors that can affect the severity of delirium. The Cox proportional hazards model was also used to investigate the survival rate of ICU patients with delirium. Methods：This study was of a prospective observational design that utilized the convenient sampling method. Data was collected from two ICUs in a teaching hospital in Tainan using structured questionnaires. A total of 160 patients were enrolled in this study. The research tools included Acute Physiology and Chronic Health Evaluation II (APACHE II), the Confusion Assessment Method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), and the Delirium Index (DI). Statistical analyses were performed by SPSS-20.0 software with descriptive statistics, (independent) two-sample t-test, chi-square test, Logistic regression analysis, multivariate linear regression analysis, and the Cox proportional hazards model. Results：The results in this study indicated that the occurrence of delirium among the subjects was 14.1 ﹪. Most of the patients were determined with low-activity delirium (90.9 %). The risk factors for delirium were determined as: &quot;hyperglycemia&quot; (2=9.71，p<.05), &quot;metabolic acidosis&quot; (2=53.59，p <.001), &quot;number of comorbidities&quot; (t=1.83，p<.01), &quot;days of ICU stay&quot; (t=-2.45，p <.05), and &quot;days waiting after notifying discharge from ICU&quot; (t=2.23，p<.05). After following-up with the patients, the important predicting factors of delirium were identified as &quot;metabolic acidosis&quot; (odds ratio [OR] = 25.50; p<.001) and &quot;days of ICU stay&quot;(OR=1.52; p<.01).Furthermore, patient delirium severity can be predicted by: older age (t=2.184; p<.05), rheumatoid arthritis (t=3.127; p<.01), hyperglycemia (t=-2.791; p<.01), metabolic acidosis (t=2.999，p<.01), number of past illnesses (t=2.504，p<.05), and number of days on mechanical ventilation (t=2.366; p<.05). The survival analysis of patient with delirium in the ICU indicated that, after controlling for age and gender, patients with metabolic acidosis were 12.82 times (p<.001) lower than patients without metabolic acidosis. Conclusions：The results in this study detailed the risk factors, the important predictors, and the individual's health status and their affect to the rate of survival after the onset of delirium. These results can be of reference for providing suitable assessment, prevention, and follow-up for the correct diagnosis and reduction of delirium to improve patient safety. Keywords：Delirium occurrence, intensive care unit, risk factor, survival analysi

Effects of Cropland Conversion on Soil Microbial Biomass and Enzymatic Activities in the Loess Hilly Area of Ningxia

在野外调查和室内实验分析的基础上,研究了宁夏黄土丘陵区农田退耕后不同植被恢复措施对土壤的微生物生物量碳、氮、磷和转化酶、碱性磷酸酶、过氧化氢酶和脲酶活性的影响。研究表明:农田退耕后通过不同的植被恢复措施,土壤的微生物生物量碳为农地的1.04~3.12倍;微生物生物量氮为农地偏高;微生物生物量磷则相对稳定,无显著差异;转化酶和碱性磷酸酶活性的提高主要表现在表层(0-5 cm土层)和5-20 cm土层,分别比农地高出1%~41%和1%~89%;过氧化氢酶活性变化幅度最小;土壤脲酶活性在表层提高的幅度最大,为农地的1.95倍。农田退耕后,通过不同的植被恢复措施,土壤的生物肥力有所提高