目的 探讨急性心肌梗死患者谵妄发生和住院病死率的关系。方法 采用回顾性队列研 究，收集美国重症监护医学信息数据库（MIMIC⁃IV）的急性心肌梗死患者。根据是否谵妄，分为谵妄组 和无谵妄组。采用逆概率加权等多种方法，评估急性心肌梗死患者谵妄发生和住院病死率的独立关系。 结果 发生谵妄的急性心肌梗死患者住院病死率较无谵妄组高 67%（逆概率加权结果：HR = 1.67，95%CI： 1.30 ~ 2.15，P < 0.001），使用多因素 Cox 回归、调整倾向性评分、倾向性评分匹配、逆概率比加权和双稳 健分析模型敏感分析显示，HR 在 1.45 ~ 1.54，结果稳定。同时 E 值为 2.73，提示考虑未控制的混杂因素， 结果依然稳定。结论 在重症监护病房的急性心肌梗死患者，谵妄的发生和住院病死率增加独立 相关。

Objective To investigate whether delirium associated with in ⁃ hospital mortality in patients with acute myocardial infarction. Methods This study used a retrospective cohort. The US Medical Information in Intensive Care database（MIMIC⁃IV）of patients with acute myocardial infarction was used to evaluate the indepen⁃ dent relationship between delirium and in⁃hospital mortality. To evaluate the independent relationship between delir⁃ ium and in ⁃ hospital mortality，inverse probability weighting was applied. Results Acute myocardial infarction patients with delirium had an in⁃hospital mortality rate that was 67% greater than those without delirium（inverse probability weighted result：HR = 1.67，95% CI：1.30 ~ 2.15，P < 0.001）. Sensitivity analyses utilizing Cox regression，adjusted propensity scores，propensity score matching，inverse probability weighting，and double robust analysis models revealed that the HR varied from 1.45 to 1.65. E value of 2.73 indicated that the results remain stable when considered uncontrolled confounding factors.）Conclusion Delirium was independently associ⁃ ated with increased in⁃hospital mortality in patients with acute myocardial infarction in the intensive care unit.