镇静镇痛集束化护理策略对脑创伤后机械通气患者谵妄的影响

Effect of cluster-based nursing strategy for sedation and analgesia on delirium in patients on mechanical ventilation after traumatic brain injury

目的评价镇静镇痛集束化护理对脑创伤后机械通气患者谵妄的影响。方法便利抽样法选取2017-04至2018-04转入神经重症ICU行机械通气的脑创伤患者90例,常规护理的同时,行镇静镇痛集束化护理措施(干预组)。另选择90例机械通气的脑创伤患者,行常规护理,作为对照组。记录患者年龄、性别、ICU住院时间、APACHEⅡ评分、谵妄发生率、机械通气时间、谵妄类型及持续时间。结果两组患者的年龄、性别、机械通气时间,以及APACHEⅡ评分差异无统计学意义,干预组在ICU的住院时间与对照组比较显著缩短[(12. 86±3. 24) d vs(16. 24±2. 63) d,P <0. 05];与对照组相比,干预组谵妄发生率明显降低(52%vs 66%,P <0. 05),谵妄持续时间显著缩短[(3. 27±0. 59) d vs (4. 79±0. 52) d,差异有统计学意义,(P <0. 05)],谵妄构成类型无统计学差异(P> 0. 05)。结论应用镇静镇痛集束化护理可减少机械通气脑创伤患者的谵妄持续时间及ICU住院时间,并降低谵妄发生率。

Objective To evaluate the effect of cluster-based nursing strategies for sedation and analgesia on delirium in patients on mechanical ventilation after traumatic brain injury.Methods Ninety patients with traumatic brain injury who were transferred to the ICU between April 2017 and April 2018 and received mechanical ventilation were selected using the convenient sampling method. They were given routine nursing and cluster-based sedation and analgesia nursing. Another 90 patients on mechanical ventilation after traumatic brain injury were treated with routine nursing as control group. Age, sex, length of ICU stay, APACHE Ⅱ score, the incidence of delirium, duration of mechanical ventilation, types and duration of delirium were recorded.Results There was no significant difference in age, sex, duration of mechanical ventilation and APACHE Ⅱ score between the two groups (P>0.05). The length of ICU stay in the intervention group was significantly shorter than that in the control group [(12.86±3.24)d vs (16.24±2.63)d, P<0.05]. Compared with the control group, the number of cases of delirium in the intervention group was significantly reduced (52% vs 66%, P<0.05), and the duration of delirium was significantly shorter [(3.27±0.59)d vs (4.79±0.52)d, P<0.05]. There was no significant difference in the types of delirium (P>0.05).Conclusions Cluster-based nursing for sedation and analgesia can effectively shorten the duration of delirium in patients on mechanical ventilation after traumatic brain injury, and reduce the incidence of delirium and ICU stay.