以谵妄评估量表评分策略为基础的分层护理对骨质疏松性髋部骨折患者术后谵妄发生率的影响

Effect of Confusion Assessment Method of Intensive Care Unit Scoring Strategy-Based Stratified Nursing on the Incidence of Postoperative Delirium in Patients with Osteoporotic Hip Fracture

目的探讨以谵妄评估量表(CAM-ICU)评分策略为基础的分层护理对骨质疏松性髋部骨折患者术后谵妄发生率的影响。方法选取郑州市骨科医院2019年2月至2020年5月收治的38例骨质疏松性髋部骨折患者设为对照组,给予所有患者常规住院护理干预,选取郑州市骨科医院2020年6月至2021年9月收治的38例骨质疏松性髋部骨折患者设为观察组,增加以CAM-ICU评分策略为基础的分层护理干预。比较两组患者干预术后谵妄发生率、不良事件发生率、心理状态变化情况、术后下床时间、住院时间及对护理满意情况。结果两组患者干预后,观察组共发生1例谵妄、1例渗血,对照组共发生8例谵妄、3例拔管、2例压力性损伤、4例渗血,观察组谵妄与不良事件发生率分别为2.63%、2.63%,均低于对照组谵妄发生率、不良事件发生率(21.05%、23.68%)(P<0.05);观察组患者术后首次下床时间及住院时间均短于对照组患者术后首次下床时间、住院时间(P<0.05);干预后两组患者焦虑自评量表(SAS)与抑郁自评量表(SDS)评分均降低,且观察组患者SAS与SDS分值低于对照组患者(P<0.05);两组患者干预后,观察组住院护理满意率为97.37%,高于对照组患者(81.58%)(P<0.05)。结论以CAM-ICU评分策略为基础的分层护理能有效降低骨质疏松性髋部骨折患者术后谵妄及相关不良事件发生率,促进机体康复,改善心理负面情绪,提升住院满意度,值得临床推广应用。

Objective To investigate the effect of confusion assessment method of intensive care unit(CAM-ICU)scoring strategy-based stratified nursing on the incidence of postoperative delirium in patients with osteoporotic hip fracture.Methods Thirty-eight patients with osteoporotic hip fracture admitted to Zhengzhou Orthopaedic Hospital from February 2019 to May 2020 were selected as the control group and given routine inpatient nursing intervention,and 38 patients with osteoporotic hip fracture admitted to Zhengzhou Orthopaedic Hospital from June 2020 to September 2021 were selected as the observation group and supplemented with stratified nursing intervention based on CAM-ICU scoring strategy.The incidence of postoperative delirium,incidence of adverse events,changes in psychological status,postoperative off-bed time,length of hospital stay and satisfaction with nursing were compared between the two groups.Results After intervention,there was 1 case of delirium and 1 case of oozing in the observation group.There were 8 cases of delirium,3 cases of extubation,2 cases of stress induced injury and 4 cases of oozing in the control group.The incidence rates of delirium and adverse events in the observation group were 2.63%and 2.63%,respectively,which were lower than those in the control group(21.05%,23.68%)(P<0.05).The first time to get out of bed and hospital stay in the observation group were shorter than those in the control group(P<0.05).After intervention,the scores of self-rating anxiety scale(SAS)and self-rating depression scale(SDS)in the two groups were decreased.The SAS and SDS scores of the observation group were lower than those of the control group(P<0.05).After intervention,the satisfaction rate of inpatient care of the observation group was 97.37%,which was higher than that of the control group(81.58%)(P<0.05).Conclusion Stratified nursing based on CAM-ICU scoring strategy can effectively reduce the occurrence of postoperative delirium and related adverse events in patients with osteoporotic hip fracture,promote physical rehabilitation,improve psychological negative emotions and hospital satisfaction,which is worthy of clinical application.