护理谵妄筛查量表与重症监护谵妄量表在PCI术后患者谵妄评估中的效果比较

Comparison of nursing delirium screening scale and intensive care delirium scale in the evaluation of delirium after percutaneous coronary intervention

目的比较护理谵妄筛查量表(nursing delirium screening scale,Nu-DESC)与重症监护谵妄量表(intensive care delirium screening checklist,ICDSC)对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者谵妄的评估能力及评估效果。方法选取2018年6月至2019年6月入住心血管外科进行PCI手术的患者128例作为研究对象,采用一般资料调查问卷、躁动-镇静评分量表(richmond agitation-sedation scale,RASS)、Nu-DESC、ICDSC进行资料收集,采用SPSS 18.0对收集的资料进行统计学分析。采用受试者工作特征曲线以及曲线下面积分析Nu-DESC量表和ICDSC量表评估PCI术后患者谵妄的能力;采用Kappa值对量表的一致性进行检验。利用Bayes判别法分析Nu-DESC、ICDSC对PCI术后患者谵妄状况判定的准确性。结果以DSM-Ⅳ判断谵妄状态作为参照,Nu-DESC量表与ICDSC量表的ROC曲线下面积分别为0.902、0.857,两者曲线下面积之差AUC=0.045(Z=3.489,P<0.001);Nu-DESC量表与ICDSC量表评估谵妄的最佳临界值分别为2和4;二者与DSM-Ⅳ方法在谵妄判定方面的交叉验证准确率分别为87.5%、83.6%;DSM-Ⅳ谵妄评估表、Nu-DESC量表和ICDSC量表评估的谵妄发生率分别为33.6%,34.4%,43.7%。结论相比ICDSC量表,Nu-DESC量表更适用于对PCI术后患者谵妄进行评估。

Objective:To compare the evaluation ability and effect of the nursing delirium screening scale(Nu-DESC)and the intensive care delirium screening checklist(ICDSC)on the patients with delirium after percutaneous coronary intervention(PCI).Methods:A total of 128 patients who were admitted to cardiovascular surgery from June 2018 to June 2019 for PCI intervention were selected by convenient sampling method.Data were collected by general data questionnaire,restless sedation scale(RASS),Nu-DESC and ICDSC.SPSS 18.0 was used to analyze the collected data.The patients'receiver operating characteristic(ROC)curve and area under the ROC curve(AUC)were used to analyze Nu-DESC scale and ICDSC scale to evaluate the delirium ability of patients after PCI.Kappa value was used to test the consistency of the scale.Bayes discriminant analysis was used to analyze the accuracy of Nu-DESC and ICDSC in judging delirium after PCI.Results:The AUC of Nu-DESC and ICDSC was 0.902 and 0.857 respectively,and the difference between them was AUC=0.045(Z=3.489,P<0.001);the best critical value of Nu-DESC and ICDSC for delirium evaluation was 2 and 4.The cross validation accuracy of Nu-DESC and ICDSC for delirium determination was 87.5% and 83.6%,respectively.The delirium rates of DSM-Ⅳ,Nu-DESC and ICDSC were 33.6%,34.4% and 43.7%,respectively.Conclusion:Compared with ICDSC,Nu-DESC is more suitable for the evaluation of delirium after PCI.