基于循证的早期活动对脑肿瘤切除患者术后谵妄的影响

Effect of early activity on postoperative delirium for patients after craniotomy:an evidence-based protocols

目的观察基于循证的早期活动训练对脑肿瘤切除患者术后谵妄发生率、持续时间等的影响。方法采用非同期对照方法,选取2019年1—12月浙江大学医学院附属第二医院神经外科行开颅肿瘤切除术且签订知情同意的238例颅脑肿瘤患者为研究对象,以连续入组的方式将2019年1月1日至6月31日符合标准的121例患者纳入对照组,实施神经外科术后护理常规;将2019年7月1日至12月31日符合入选标准的117例患者纳入观察组,实施基于循证的系统化早期活动训练。比较2组患者谵妄发生率、持续时间、谵妄相关不良事件、巴氏指数、术后住院日、住院费用的差异。结果观察组患者谵妄发生率、谵妄持续时间、术后住院日分别为9.5%、2.0(1,3)d、7(5,10)d,低于对照组的23.3%、3.0(1,5)d、8(6,11)d,差异有统计学意义(χ^(2)值为8.17、Z值为2.96、-2.01,均P<0.05)。观察组出院后1周及1个月巴氏指数为90(85,90)、100(100,100),高于对照组的90(86,90)、100(100,100),差异有统计学意义(Z值为-2.41、-2.46,P<0.05);不良事件的比较,观察组为0例,对照组为1例,差异无统计学意义(χ^(2)值为0.97,P>0.05)。结论脑肿瘤切除患者实施基于循证的早期活动可以降低术后谵妄的发生率、缩短谵妄持续时间及术后住院时间,提高患者术后生活自理能力,而且是安全有效的。

Objective To observe the effect of evidence-based early activity training on postoperative delirium in patients with brain tumor resection.Methods This study used non-contemporary comparison method,a total of 238 patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in 2019,were included.121 patients who met the inclusion criteria and signed informed consent after craniotomy during January lst,2019 to June 31th,2019 were included in the control group,and 117 patients who met the criteria and obtained informed consent after craniotomy during July 1 to December 31,2019,were included in the experimental group.Neurosurgical postoperative routine nursing care were given to the control group.The experimental group received evidence-based early activity training.The incidence of delirium,duration of delirium,Barthel Index(BI),delirium-related adverse events and other indicators of postoperative hospitalization were compared between two groups.Results The incidence of delirium,duration of delirium and postoperative hospital stay in the experimental group were 9.5%,2.0(1,3)days and 7(5,10)days,lower than 23.3%,3.0(1,5)days and 8(6,11)days in control group,and the differences were statistically significant (χ^(2) value was 8.17,Z value were 2.96 and-2.01,P<0.05).BI index 1 week and 1 month after discharge in the experimental group was 90(85,90),100(100,100),higher than the control group of 90(86,90)and 100(100,100),with statistically significant difference(Z values were-2.41 and-2.46,P<0.05),the comparison of adverse events,0 case in experimental group,1 case in control group,there was no statistically significant difference (χ^(2) value was 0.97,P>0.05).Conclusions Early evidence-based activities in patients with brain tumor resection can reduce the incidence of postoperative delirium,shorten the duration of postoperative delirium and postoperative hospital stay,and improve the ability of patients to take care of themselves after surgery,which is safe and effective.