护理谵妄筛查量表在全麻苏醒期老年患者中的应用研究

Feasibility of Nu-DESC in Screening Delirium of Elderly Patients in PACU

目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果 303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。

Objective To evaluate the feasibility of Nu-DESC in screening delirium of elderly patients in PACU （post anesthesia care unit）. Methods Elderly patients aged over 65 receiving selective non-cardiac surgery under general anesthesia and admitted in PACU were recruited and evaluated by CAM-ICU and Nu-DESC successively. With CAM-ICU serving as a standard, the sensitivity and specificity of Nu-DESC were assessed. Results A total of 303 patients were included in this research. According to the diagnosis of CAM-ICU, the incidence of delirium was 25.7% and area under the ROC curve of Nu-DESC 0.825. when threshold value reached 3, the sensitivity and specificity of Nu-DESC was 65.3% and 99.6% respectively and the kappa 0.707 （P〈0.01）. Conclusion Nu-DESC is a convenient and easy to master delirium detection scale. It could be used as an efficient method to screen delirium of elderly patients in PACU.