强化护理干预对ICU老年患者术后谵妄转归的影响

Effect of intensive nursing intervention on postoperative delirium in elderly patients with ICU

目的:探讨强化护理干预对ICU老年患者术后谵妄(postoperative delirium,POD)转归的影响效果。方法:选取ICU的60例老年POD患者,随机将其分为对照组和观察组,每组各30例。两组术后均积极给予原发疾病治疗和ICU病情监护,对照组给予POD常规护理,观察组在对照组基础上给予系列强化护理干预手段。住院期间每日密切观察,采用ICU精神错乱评估表(CAM-ICU)和ICU常用的精神障碍探测量表(DDS)评估两组POD转归情况,统计相关并发症情况。结果:CAMICU量表评估提示两组患者POD阳性率呈逐渐下降趋势,其中观察组发病3 d后POD阳性率16. 67%(5/30),低于对照组的40. 00%(12/30),差异具有统计学意义(P <0. 05);观察组护理干预3 d后DDS量表评分较入组时、对照组护理干预3 d时评分降低,差异均具有统计学意义(P <0. 05);观察组POD转归效果满意,ICU住院期间不良事件发生率为13. 33%(4/30),低于对照组的43. 33%(13/30),差异具有统计学意义(P <0. 05)。结论:采取针对性的强化护理手段,可有效缓解ICU老年POD患者症状,促进病情转归,降低相关并发症风险,减少对ICU住院及治疗的影响。

Objective： To explore the effect of intensive nursing intervention on postoperative delirium （POD） outcome in elderly patients with ICU. Methods： 60 elderly patients with POD were selected from ICU.They were randomly divided into the control group and the observation group,30 cases in each group.The two groups were actively treated for the primary disease and ICU monitoring basis,the control group was given POD routine nursing,and the observation group was given a series of intensive nursing intervention on the basis of the control group.During the period of hospitalization,two groups of POD outcomes were assessed by ICU mental disorder assessment （CAM-ICU） and ICU psychotic probe meter （DDS）,and the related complications were statistically analyzed. Results： The CAM-ICU scale showed that the positive rate of POD in the two groups was gradually decreasing,and the positive rate of POD 3 d after the onset in the observation group [16.67% （5/30）] was lower than that of the control group [40% （12/30）],and the difference was statistically significant （ P 〈0.05）.After 3d of nursing intervention,the score of the DDS scale in the observation group was lower than those in group and the control group,the difference was statistically significant （ P 〈0.05）.The effect of POD in the observation group was satisfactory,and the incidence of adverse events in ICU was 13.33% （4/30）,which was lower than that of the control group （43.33% （13/30））,and the difference was statistically significant （ P 〈0.05）. Conclusion： The targeted intensive care can effectively alleviate the symptoms of ICU elderly POD patients and promote the prognosis of the disease,reduce the risk of related complications,reduced effects on ICU hospitalization and treatment.