NEECHAM意识模糊量表对评估患者谵妄的可靠性研究

Study of Reliability of NEECHAM Confusion Scale on assessing Delirium in Intensive Care

目的探讨NEECHAM意识模糊量表（NEECHAM）评估谵妄的可靠性。方法采取整群抽样的方法，选择我院综合重症监护室（ICU）收治的176例非气管插管患者作为研究对象，由一名综合ICU护士每隔8—12h同时采用NEECHAM和ICU意识模糊评估法（CAM—ICU）对每住患者进行一次谵妄评估。结果CAM-ICU显示谵妄发病率为20．5％，NEECHAM显示没有谵妄的占25．6%，具有谵妄风险的占28．496，轻度谵妄的占25．096，中、重度谵妄的占21．0％。NEECHAM诊断谵妄的敏感度和特异度分别为86．1％，95．7％；阳性预期值和阴性预期值分别为83．8％，96．4％。NEECHAM评分与患者住院时间呈显著正相关（r=0．58，P〈0．01）。结论以CAM-ICU为诊断标准，NEECHAM具有较高的灵敏度和特意度。而且可以根据得分分为没有谵妄，具有谵妄风险，轻度或早期谵妄，中、重度谵妄4个类别。因此，NEECHAM是ICU中早期发现谵妄的重要筛查工具。

Objective To explore the reliability of the Neelon and Champagne （NEECHAM） Confusion Scale on assessing delirium in intensive care. Methods A cluster sampling method was adopted in this cress sectional study. A consecutive sample of 176 uon-intubated patients in a mixed ICU of our hospital was assessed after a stay in the ICU for at least 24 hours. All adult patients with a Glasgow Coma Scale score of greater than 9 were included. A nurse researcher simultaneously assessed both scales every 8-12h .Results The CAM-ICU showed a 20.5% incidence of delirium.Tbe NEECHAM scale detected incidence rates of 21.0% for delirious, 25.0% for confused, 28.4% for at risk, and 25.6% for normal patients. The majority of the positive CAM-ICU patients were detected by the NEECHAM scale （31/36）. The sensitivity of the NEECHAM scale was 86.1% and the specificity was 95.7%. The positive predictive value and the negative predictive value were 83.8% and 96.4%, respectively. Additionally, the NEECHAM scale scores showed a positive correlation with the length of stay in days（r=-0.58,P〈0.01）.Condusion Based on CAM-ICU criteria, In non- intubated patients,the sensitivity and the specificity of the NEECHAM scale proved to be good in all patients. Additional confused patients were identified in the categorical approach of the scale. The NEECHAM scale proved to be a valuable screening tool compared with the CAM-ICU in the early detection of intensive care delirium by nurses.