摘要
目的描述3种不同类型的ICU谵妄发生率及谵妄严重程度的变化,对谵妄持续时间、机械通气时间、ICU住院时间、抗精神病药物使用时间等相关临床结局进行比较。方法选取某三级甲等医院I CU 2016年4月—2017年1月发生谵妄的患者为研究对象,使用I CU患者意识模糊评估法(Confusion Assessment Method of Intensive Care Unit,CAM-ICU)进行谵妄评估,使用重症监护谵妄筛查量表(Intensive Care Delirium Screening Checklist,ICDSC)进行谵妄筛查,收集患者的临床资料,统计学分析采用Kaplan-Meier法绘制生存曲线并进行Logrank检验。结果躁动型谵妄症状严重程度最高,安静型谵妄症状严重程度最低。混合型谵妄、安静型谵妄、躁动型谵妄所占比例分别为51.9%,39.0%,9.1%,混合型谵妄所占比例最大,且谵妄持续时间、机械通气时间、ICU住院时间及抗精神病药物使用时间均最长。结论医护人员可根据谵妄类型实施有针对性的治疗及护理。躁动型谵妄症状最显著,可遵医嘱使用药物进行短期症状控制;混合型谵妄短期临床结局最差,医护人员应加强谵妄监测,落实谵妄管理策略,制订脱机拔管计划,尽量减少抗精神病药物的使用。
Objective To describe the prevalence and change of severity for three different subtypes of ICU delirium,and to compare duration of delirium,length of mechanical ventilation,length of ICU stay,and usage of antipsyehoties. Methods We studied patients who were delirium positive from April 2016 to January 2017 in the Intensive Care Unit in Peking Union Medical College Hospital. We assessed the patients with the Confusion Assessment Method of Intensive Care Unit （CAM-ICU） and the Intensive Care Delirium Screening Cheeklist（ICDSC）. The general and clinical data were collected. We used the Kaplan-Meier survival curve and Log-rank test to analyze the differences. Results Hyperactive delirium was the type with the highest symptom severity,and the hypoaetive delirium was the lowest. Mixed delirium,hypoactive delirium and hyperactive delirium accounted for 51.9%,39.0%, and 9.1% ,respectively. The mixed delirium was the most common type among the three. Duration of delirium, length of mechanical ventilation,length of ICU stay ,and usage of antipsychoties were longest for patients with mixed delirium. Conclusion Targeted treatment and nursing should be provided according to different types of delirium. Medicine can be used to control short-term symptoms of hyperactive delirium. Patients with mixed delirium have the worst outcomes,and intensified delirium monitoring,enhanced management strategies,and plan for extubation should be applied,and usage of antipsychoties should be minimized.
作者
孙丹丹
柴文昭
郭海凌
孙建华
朱丽娜
张亚青
戎珊
叶久航
郝翠平
梁涛
SUN Dandan;CHAI Wenzhao;GUO Hailing;SUN Jianhua;ZHU Lina;ZHANG Yaqing;RONG Shan;YE Jiuhang;HAO Cuiping;LIANG Tao(Department 3 of ICU,Affiliated Hospital of Jining Medical University,Shandong,272029, Chin)
出处
《中华护理杂志》
CSCD
北大核心
2018年第7期778-782,共5页
Chinese Journal of Nursing
关键词
重症监护病房
谵妄
临床结局
Intensive Care Units
Delirium
Clinical Outcomes
