两种谵妄评估表在神经外科非机械通气患者中的应用比较

Comparison of two delirium assessment tools in neurosurgery patients without mechanical ventilation

目的探讨重症监护谵妄筛查量表(ICDSC)与意识模糊量表(NEECHAM)在评估神经外科非机械通气患者时的信效度。方法选取2018年8—12月入住山西省某三级甲等医院神经外科非机械通气患者100例,将非手术患者入院后第3天或手术患者术后第3天订为评估日,于00:00?—1:00、8:00?—9:00、16:00?—17:00共3个时间段由培训合格的护士采用ICDSC与NEECHAM进行谵妄评估,精神科医师于当日16:30?—17:30采用躁动-镇静评分量表(RASS)和精神疾病诊断与统计手册(DSM-IV)对患者进行谵妄评估。以DSM-IV结果作为金标准,绘制受试者工作特征(ROC)曲线,并比较2个量表的灵敏度、特异度等。结果ICDSC的ROC曲线下面积为0.891(95%CI:0.826~0.956,P<0.01)。NEECHAM的ROC曲线下面积为0.987(95%CI:0.970~0.999,P<0.01)。ICDSC最佳界值取4.25分时,灵敏度为87.8%,特异度为76.2%;NEECHAM最佳界值取23.5分时,灵敏度为98.0%,特异度为92.9%。结论NEECHAM漏诊率和误诊率低于ICDSC,诊断效能、真实性、可靠性、诊断价值高于ICDSC,更适用于护士对神经外科非机械通气患者进行谵妄评估。

Objective To compare the reliability and validity of Intensive Care Delirium Screening Checklist(ICDSC)and Neelon and Champagne Confusion Scale(NEECHAM)when evaluating non-mechanical ventilation patients in Neurosurgery Department.Methods A total of 100 non-mechanical ventilation patients in the Neurosurgery Department of a ClassⅢGrade A hospital in Shanxi Province from August to December 2018 were selected.The non-operative patients were assessed on the third day after admission,and the operative patients were assessed on the third day after operation.Qualified nurses assessed the patients at 00:00-1:00,8:00-9:00 and 16:00-17:00 with ICDSC and NEECHAM.Psychiatrists assess the patients at 16:30-17:30 on the same day by Richmond Agitation and Sedation Scale(RASS)and Diagnostic and Statistical Manual of Mental Disorders IV(DSM-IV).Using the results of DSM-IV as the gold standard,the curve of ROC was drawn,and the sensitivity and specificity of the two scales were compared.Results Area under ROC Curve(ROCAUC)of ICDSC was 0.891(95%CI:0.826-0.956,P<0.01).The ROCAUC of NEECHAM was 0.987(95%CI:0.970-0.999,P<0.01).When the optimal threshold of ICDSC was 4.25,the sensitivity and specificity were 87.8%and 76.2%respectively.When the optimal threshold of NEECHAM was 23.5,the sensitivity and specificity were 98.0%and 92.9%respectively.Conclusions The misdiagnosis rate of NEECHAM is lower than ICDSC,and the diagnostic efficacy,authenticity,reliability and diagnostic value of NEECHAM are higher than ICDSC.NEECHAM is more suitable for nurses to evaluate delirium in neurosurgery patients without mechanical ventilation.