谵妄预防护理方案在老年食管癌手术患者中的应用

The application of preventive nursing interventions for postoperative delirium in elderly esophageal cancer patients with surgical resection

目的探讨针对老年食管癌手术患者实施谵妄预防护理方案的效果。方法 108例拟行食管癌根治术的老年食管癌患者分为对照组和观察组,各54例。对照组接受食管癌常规护理方案,观察组在对照组基础上实施谵妄预防护理方案,包括改良呼吸功能训练、术后早期活动方法指导、制定术前访视用漫画图文手册、确定预防性镇痛方案。评估2组患者手术前晚焦虑情绪和术后72 h疼痛评分,观察术后72 h谵妄阳性发生情况。结果依据焦虑自评量表(SAS)评估焦虑情绪,观察组手术前晚有中重度焦虑情绪32(59. 26%)例,低于对照组的44(79. 63%)例,差异有统计学意义(P <0. 05)。依据Prince-Henry评分法评估疼痛,术后72 h观察组评分3~5分的有3(5. 56%)例,少于对照组的10(18. 52%)例,差异有统计学意义(P <0. 05)。依据意识模糊评估量表(CAM),察组患者谵妄阳性13(24. 07%)例,少于对照组的24(44. 44%)例,差异有统计学意义(P <0. 05)。结论针对引发术后谵妄的疼痛、焦虑、低氧血症等可控危险因素,制定并实施谵妄预防护理方案,可以降低老年食管癌术后谵妄的发生风险。

Objective To investigate the clinical efficacy of preventive nursing interventions for postoperative delirium nursing in elderly patients undergoing surgical resection for esophageal cancer. Methods A total of 108 patients undergoing radical surgery for esophageal cancer were enrolled and assigned to the control group and the observation group, with 54 cases in each group. Patients of both two groups were given routine care on esophageal cancer, and those in the obser- vation group were given preventive nursing interventions, including modified respiratory function training, guidance of postoperative exercise, comic materials for preoperative visit, and plan for postoperative prophylactic analgesia. The anxiety of patients on the night before surgery, pain de- gree and the incidence of delirium within 72 hours after surgery were compared between two groups. Results According to the Self-rating Anxiety Scale （SAS）, there were 32 （59.26%） patients in observation group and 44 （79.63 % ） patients in the control group with moderate to se- vere anxiety on the night before surgery （P 〈 0.05 ）. According to the Prince-Henry score, there were 3 （5.56%） patients in observation group and 10 （ 18.52% ） patients in the control group with grade 3-5 pain score within 72 hours after surgery （P 〈 0.05 ）. According to the Consciousness And Memory scale （CAM）, there were 13 （24.07%） patients in observation group and 24（44.44%） patients in the control group with positive delirium （P 〈 0.05 ）. Conclusion Ac- cording to influential factors of postoperative delirium such as pain, anxiety, hypoxemia and so on, the development and implementation of preventing nursing interventions are effective to reduce the risk of postoperative delirium in elderly esophageal cancer patients with surgical resection.