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目的:应用静息态功能磁共振成像（fMRI）技术分析重症监护病房（ICU）谵妄患者的脑功能，应用扩散张量成像（DTI）技术进一步分析谵妄患者的脑区结构变化，从功能影像学的新视角探讨ICU谵妄患者脑功能、结构变化及相关性，为谵妄的诊断提供可视化依据。方法:选择2017年1月1日至12月31日在遵义医科大学附属医院ICU住院的谵妄患者作为研究对象；选择同期与谵妄患者性别、年龄、文化程度相匹配的健康志愿者作为对照组。记录患者入ICU 24 h内重症监护谵妄筛查量表（ICDSC）评分。所有受试者均通过fMRI和DTI技术进行磁共振扫描，采用脑区局部一致性（ReHo）数据分析方法评估谵妄患者静息态脑功能的异常变化；采用FSL软件进行DTI数据处理，分别提取脑区的各向异性分数（FA）和平均弥散率（MD），评估脑结构损伤情况；比较两组间的ReHo、FA及MD值。提取谵妄患者ReHo值较健康对照者降低具有统计学意义脑区的ReHo值与ICDSC评分进行Pearson相关分析。结果:共选择22例谵妄患者，剔除检查过程中不配合、使用镇静剂及扫描结果伪影者7例，最终共15例患者纳入谵妄组；共15例健康志愿者纳入健康对照组。①两组受试者性别、年龄、受教育时间比较差异无统计学意义；谵妄组患者ICDSC评分明显高于健康对照组（分：6.07±1.28比1.07±0.88，n P<0.01）。② fMRI扫描及分析结果：与健康对照组相比，谵妄组患者小脑、右侧海马、纹状体、中脑、脑桥的ReHo值明显升高（均n P<0.05，AlphaSim校正），而双侧额上回、双侧额中回、左侧额下回、颞叶、顶叶的ReHo值明显降低（均n P<0.05，AlphaSim校正）。相关分析显示，谵妄患者左侧额上回ReHo值与ICDSC评分呈显著负相关（n r＝-0.794，n P<0.05），说明额内侧回脑功能区改变与谵妄的发生最密切。③ DTI扫描及分析结果：与健康对照组相比，谵妄组患者左侧小脑、双侧额叶、左侧颞叶、胼胝体、左侧海马的FA值明显降低（均n P<0.05，AlphaSim校正），而额内侧回、右侧颞上回、前扣带回、双侧岛叶、左侧尾状核的MD值明显升高（均n P<0.05，AlphaSim校正），提示谵妄患者多个脑区结构和功能受损。n 结论:谵妄患者多个脑区静息脑功能活动异常，左侧额上回静息脑功能活动异常与谵妄的发生密切相关；谵妄患者多个脑区存在结构损伤；额叶、颞叶、胼胝体、海马、小脑结构改变且功能异常可作为谵妄诊断的初步影像学评价指标。“,”Objective:To analyze the brain function of patients with delirium in intensive care unit (ICU) using resting-state functional magnetic resonance imaging (fMRI), further analyze the structural changes in the brain using diffusion tensor imaging (DTI), and explore the correlations of brain function with structural changes in patients with delirium in ICU from a new perspective of functional imaging, provide visual evidence for the diagnosis of delirium.Methods:Patients with delirium admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st in 2017 were enrolled as subjects. During the same period, the healthy volunteers who matched the gender, age and education level of the patients with delirium were enrolled as control group. The intensive care delirium screening checklist (ICDSC) scores within 24 hours after ICU admission were recorded. All the subjects were scanned by fMRI and DTI. The abnormal changes in resting-state brain function of the patients with delirium were evaluated by cerebral regional homogeneity (ReHo) data analysis. The DTI data were processed by the FSL software, and the fractional anisotropy (FA) and mean diffusivity (MD) of the brain were extracted, respectively, to evaluate the damage to brain structure. The values of ReHo, FA and MD were compared between the two groups. The ReHo value of brain region with reduced ReHo value of patients with delirium as compared with the healthy volunteers was extracted for Pearson correlation analysis with ICDSC scores.Results:A total of 22 patients with delirium were included. Seven patients who did not cooperate in the examination, used sedatives or had false images in scanning, were excluded. Finally, 15 patients were enrolled in the delirium group, and 15 healthy volunteers in the healthy control group. ① No statistically significant difference was found in gender, age or education time between the two groups. ICDSC score of the delirium group was significantly higher than that of the healthy control group (6.07±1.28 vs. 1.07±0.88, n P < 0.01). ② fMRI scanning and analysis results: compared with the healthy control group, the ReHo values of the cerebellum, right hippocampus, striatum, midbrain and pons in the delirium group were significantly increased (all n P < 0.05, AlphaSim correction), while the ReHo values of bilateral superior frontal gyrus, bilateral median frontal gyrus, left inferior frontal gyrus, temporal lobe and parietal lobe were significantly lowered (all n P < 0.05, AlphaSim correction). Correlation analysis showed that the ReHo value of the left superior frontal gyrus was negatively correlated with ICDSC score in the patients with delirium ( n r = -0.794, n P < 0.05), indicating that the changes in the functional area of the medial frontal gyrus was most closely related to delirium. ③ DTI scanning and analysis results: compared with the healthy control group, the FA values of the left cerebellum, bilateral frontal lobes, left temporal lobe, corpus callosum and left hippocampus in the delirium group were decreased significantly (all n P < 0.05, AlphaSim correction), while the MD values of the medial frontal gyrus, right superior temporal gyrus, anterior cingulate gyrus, bilateral insular lobes and left caudate nucleus were enhanced significantly (all n P < 0.05, AlphaSim correction), suggesting that the structural and functional damage was found in multiple brain regions in patients with delirium.n Conclusions:Multiple brain regions of patients with delirium present abnormal resting-state brain function. The abnormal resting-state brain function of the left superior frontal gyrus is closely related to the occurrence of delirium. Structural damage is found in multiple brain regions of patients with delirium. The structural changes in the frontal lobe, temporal lobe, corpus callosum, hippocampus and cerebellum and their abnormal functions can be used as preliminary imaging indexes for the diagnosis of delirium.