集束化干预理念在食管癌患者术后谵妄中的应用

Application of bundles of intervention for treatment of postoperative delirium in patients with esophageal cancer

目的 探讨集束化干预理念在食管癌患者术后谵妄治疗中的应用。方法 回顾性分析2015年1 1月至2016年8月南京医科大学附属淮安第一医院应用集束化干预理念治疗食管癌术后伴发谵妄的患者36例（研究组），并以2015年1月至10月间接受常规治疗的41例食管癌术后伴发谵妄患者作为对照（对照组）。结果研究组和对照组患者术后谵妄平均持续时间分别为（3．6±0．8）d、（4．7±1．2）d，差异有统计学意义（=t4．783，P〈0．01）；研究组和对照组其他并发症发生率分别为19．4％（7／36）、34．1％（14／41），差异无统计学意义（χ^2=2．089，P=0．148）。研究组和对照组患者谵妄期间意外事件发生率分别为13．9％（5／36）、31．7％（13／41），差异有统计学意义（χ^2=4．232，P=0．040）。两组患者术后排气时间、拔除胸管时间比较，差异均无统计学意义（均P〉0．05），但两组术后住院时间和住院总费用比较，差异均有统计学意义（t值分别为4．726、2．065，均P〈0．05）。结论集束化干预理念应用于食管癌患者术后谵妄的治疗是有效、可行的，可缩短患者术后谵妄的持续时间，加速康复。

Objective To investigate the application of bundles of intervention in the treatment of postoperative delirium in esophageal cancer. Methods Thirty-six cases of delirium associated with esophageal cancer （study group） after the application of bundles of intervention in the Affiliated Huaian No.1 People＇s Hospital of Nanjing Medical University from November 2015 to August 2016 were analyzed, and 41 cases of postoperative delirium （control group） from January 2015 to October 2015 were treated by routine treatment. Results The mean duration of postoperative delirium was （3.6±0.8） d in the study group and （4.7± 1.2） d in the control group, and the difference was statistically significant （t = 4.783, P 〈 0.01）. The incidence rates of other complications in the study group and control group were 19.4 % （7/36） and 34.1% （14/41）, respectively, and there was no significant difference χ^2 = 2.089, P = 0.148）. The incidence rates of accidental events in the study group and control group were 13.9 % （5/36） and 31.7 % （13/41）, respectively, and the difference was statistically significant χ^2= 4232, P = 0.040）. There was no significant difference in the postoperative exhaust time and removal of chest tube drainage time between the two groups （both P 〉 0.05）, but there was a significant difference in postoperative hospital stay and hospital costs between the two groups （t values were 4.726 and 2.065, both P 〈 0.05）. Conclusions In the treatment of postoperative delirium in esophageal cancer, applying the bundles of intervention concept is feasible and effective. It can significantly reduce postoperative delirium duration and accelerate the rehabilitation of patients.