高龄髋部骨折患者围手术期谵妄护理管理方案的构建及应用

Construction and application of perioperative delirium nursing management protocol for patients over 80 years old with hip fracture

目的:构建高龄髋部骨折患者围手术期谵妄的护理管理方案并评价其应用效果。方法:在循证方法指导下形成高龄髋部骨折患者谵妄护理管理方案。选取2015年7月1日至2017年6月31日于北京市某三级甲等医院治疗的高龄髋部骨折患者为对照组,采用常规护理方案;2017年7月1日至2019年6月31日的高龄髋部骨折患者为实验组,采用围手术期谵妄护理管理方案。比较两组患者谵妄发生率、谵妄持续时间、睡眠时间及非计划性拔管等护理安全指标的差异。结果:实验组患者谵妄发生率、谵妄持续时间低于对照组,睡眠时间高于对照组,差异有统计学意义(P<0.05);非计划性拔管等护理不良事件的发生率两组相比差异无统计学意义(P>0.05),但实验组发生率低于对照组。结论:高龄髋部骨折患者谵妄护理管理方案有助于降低谵妄发生率及谵妄持续时间,提高患者总体睡眠时间,降低非计划性拔管等护理不良事件发生率。

Objective:To construct the nursing management protocol of perioperative delirium for elderly patients with hip fracture and evaluate its effects.Methods:Under the guidance of evidence-based methodology,the nursing management protocol of perioperative delirium for patients over 80 years old with hip fracture was formed.The patients who were admitted to the hospital from July 1,2015 to June 31,2017 were selected as the control group and followed the routine nursing protocol.The patients who were admitted to the hospital from July 1,2017 to June 31,2019 were selected as the experimental group.The perioperative delirium nursing management protocol was used.The differences of nursing safety indexes such as delirium incidence rate,duration of delirium,duration of sleep and unplanned extubation rate were compared.Results:The incidence rate and duration of delirium in the experimental group was lower than that in the control group.Yet,duration of sleep in the experimental group was higher than that in the control group.All these differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence rate of nursing adverse events such as unplanned extubation between the two groups(P<0.05),but the incidence rate in the experimental group was lower than that in the control group.Conclusion:The nursing management protocol of perioperative delirium for patients over 80 years old with hip fracture helps to reduce the incidence rate and duration of delirium,increase the overall duration of sleep for patients,and reduce the incidence rate of nursing adverse events such as unplanned extubation.