摘要
目的研究谵妄干预管理的最佳证据对危重症患者临床结局及预后的影响。方法纳入2020年1月至2021年12月收治的96例危重症患者作为研究对象,根据干预方式分为对照组(常规护理)和研究组(基于最佳证据的谵妄干预管理),每组58例。观察2组患者干预前后急性生理学与慢性健康状况评分(APACHEⅡ评分)和重症监护谵妄筛查检查表评分(ICDSC评分)以及应激指标和脑内神经递质水平,同时观察2组患者谵妄发生情况、临床结局、谵妄相关风险事件发生情况、谵妄持续时间、机械通气时间和ICU住院时间。结果观察2组患者各项观察指标发现,2组干预前指标差异无统计学意义(P>0.05),干预后研究组APACHEⅡ评分、ICDSC评分、皮质醇(Cor)、血清促肾上腺皮质激素(ACTH)、多巴胺(DA)、去甲肾上腺素(NE)均低于对照组(t=2.380、2.433、2.447、2.302、2.767、2.466,P=0.019、0.017、0.016、0.023、0.010、0.015,P<0.05),研究组谵妄发生率、死亡病例和谵妄相关风险事件发生率均短于对照组(t=4.951、4.245、5.583,P=0.026、0.039、0.018,P<0.05),研究组谵妄持续时间、机械通气时间和ICU住院时间均短于对照组(t=2.600、2.118、2.231,P=0.011、0.036、0.028,P<0.05)。结论谵妄干预管理的最佳证据对危重症患者的干预效果良好,可降低患者谵妄和谵妄相关风险事件发生的发生风险和严重程度,改善机体应激反应和脑神经指标,促进其康复进程,改善患者预后和临床结局。
Objective To investigate the effect of the optimal evidence of delirium intervention management on clinical outcome and prognosis in critically ill patients.Methods A total of 96 critically ill patients admitted to our hospital from January 2020 to December 2021 were included as the study subjects.According to the intervention methods,they were divided into control group(managed by routine nursing)and study group(managed by delirium intervention management based on the optimal evidence),with 58 patients in each group.The acute physiology and chronic health status(APACHEII score),ICU delirium screening checklist score(ICDSC),stress index,brain neurotransmitter levels,the incidence of delirium,clinical outcome,incidence of delirium-related risk events,duration of delirium,duration of mechanical ventilation and length of stay in ICU in 2 groups were observed.Results The observed indicators before intervention were comparable between the two groups(P>0.05).After intervention,the APACHEII score,ICDSC score,cortisol(Cor),serum adrenocorticotropin(ACTH),dopamine(DA)and noradrenaline(NE)in the study group were significantly lower than those in the control group(t=2.380,2.433,2.447,2.302,2.767 and 2.466,respectively;P=0.019,0.017,0.016,0.023,0.010 and 0.015,respectively;P<0.05).The incidences of delirium,death and delirium-related risk events in the study group were significantly lower than those in the control group(t=4.951,4.245 and 5.583,respectively;P=0.026,0.039 and 0.018,respectively;P<0.05).The duration of delirium,mechanical ventilation time and ICU stay in the study group were significantly shorter than those in the control group(t=2.600,2.118,and 2.231,respectively;P=0.011,0.036,and 0.028,respectively;P<0.05).Conclusion The optimal evidence of delirium intervention management has a good effect on critically ill patients,which reduces the risk and severity of delirium and delirium-related risk events,and improves the stress response,neurological indicators,rehabilitation process,prognosis and clinical outcome.
作者
贺欢
马瑛
彭晓红
HE Huan;MA Ying;PENG Xiaohong(Second Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Urumqi 830054,China)
出处
《河北医药》
CAS
2023年第11期1744-1747,共4页
Hebei Medical Journal
基金
新疆护理学会科研项目(编号:2018XH45)。
关键词
谵妄
干预
管理
最佳证据
危重症患者
临床结局
预后
delirium
intervention
management
optimal evidence
critically ill patients
clinical outcome
prognosis
