ICU患者疼痛、躁动、谵妄护理管理评估与策略及实施现状
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摘要
疼痛、躁动、谵妄在ICU经常发生且联系紧密。本文结合国内外治疗指南解析疼痛、躁动、谵妄护理管理评估相关内容及国内外的管理策略,并对实施现况进行分析,以期为临床护士提供实践参考依据并推动相关系统培训体系的建立。
Pain, Agitation, and Delirium(PAD) is common among critically ill patients. This article reviewed nursing evaluation, management strategies and ICU PAD guidelines. We hope this review will help ICU nurses advance the management of PAD in critically ill patients, and improve patients' clinical outcomes, as well as promote establishing relevant training system for ICU nurses.
Pain, Agitation, and Delirium(PAD) is common among critically ill patients. This article reviewed nursing evaluation, management strategies and ICU PAD guidelines. We hope this review will help ICU nurses advance the management of PAD in critically ill patients, and improve patients' clinical outcomes, as well as promote establishing relevant training system for ICU nurses.
引文
[1]赵海琴.全麻手术患者麻醉复苏期的躁动因素分析与护理.实用临床医药杂志,2017,21(18):88-90.Zhao HQ.Factors of agitation during the recovery period of general anaesthesia and its nursing strategy.Journal of Clinical Medicine in Practice,2017,21(18):88-90.
[2]Hansen-Flaschen JH,Brazinsky S,Basile C,et al.Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure:a national survey.JAMA,1991,266(20):2870-2875.
[3]Balzer F,Wei?B,Kumpf O,et al.Early deep sedation is associated with decreased in-hospital and two-year follow-up survival.Critical Care,2015,19(1):1-9.
[4]Shehabi Y,Bellomo R,Reade MC,et al.Early intensive care sedation predicts long-term mortality in ventilated critically ill patients.American Journal of Respiratory&Critical Care Medicine,2012,186(8):724-731.
[5]Brown CH,Azman AS,Gottschalk A,et al.Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair//中国中西医结合麻醉学会[csia]年会暨全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会,2015:977-980.Brown CH,Azman AS,Gottschalk A,et al.Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair//The Annual Meeting for Chinese socity of Chinese and Western Integrative Anesthesia and National symposium on integrated Chinese and western medicine in anesthesia,Jiangsu provincial association of Chinese and western medicine and the establishment of the professional committee of anesthesia conference,2015:977-980.
[6]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit.Critical Care Medicine,2013,41(1):263-306.
[7]中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南.中华重症医学电子杂志:网络版,2018(2):1.Society of Critical Care Medicine,Chinese Medical Association.Guidelines of analgesia and sedation for Chinese adults.Chinese Journal of Critical Care Medicine(Electronic Editon),2018(2):1.
[8]Chanques G,Pohlman A,Kress JP,et al.Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report.Critical Care,2014,18(5):R160.
[9]Severgnini P,Pelosi P,Contino E,et al.Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients:prospective,observational study.Journal of Intensive Care,2016,4(1):68.
[10]李青栋,万献尧,谷春梅,等.中文版ICU患者疼痛观察工具在机械通气患者应用的信度与效度.中华内科杂志,2012,51(8):642-643.Li QD,Wan XY,Gu CM,et al.Validity and reliabity of pain observation tool for ICU patients in machinery ventilates patient(Chinese version).Chinese Journal of Internal Medicine,2012,51(8):642-643.
[11]陈杰,杨晓红,路潜,等.中文版重症监护疼痛观察工具在非气管插管患者中应用的信效度研究.中华护理杂志,2015,50(9):1132-1136.Chen J,Yang XH,Lu Q,et al.Psychometic properties analysis of ICU Pain Observation Tool in Patients without Tracheal Intubation(Chinese Version).Chinese Journal of Nursing,2015,50(9):1132-1136.
[12]张盼,张春华,朱小平.应用重症监护疼痛观察工具评估重症监护患者疼痛的Meta分析.中华现代护理杂志,2016,22(4):526-530.Zhang P,Zhang CH,Zhu XP.Application of CPOT on pain evaluation in ICU critical patients:a Meta-analysis.Journal of Modern Nursing,2016,22(4):526-530.
[13]周丹,孙运波,姜文彬,等.ICU医护人员对疼痛、躁动和谵妄管理循证知识的认知调查.护理管理杂志,2014,14(11):780-782.Zhou D,Sun YB,Jiang WB,et al.Investigation of doctors'and nurses'perceptions towards the evidence-based management of pain,agitation and delirium.Journal of Nursing Administration,2014,14(11):780-782.
[14]朱明明,刘芳,王冉.躁动镇静评分在重症患者中应用的研究进展.中华护理杂志,2018,53(2):247-250.Zhu MM,Liu F,Wang R.The application of Agitation and Sedation Scale in critical patients.Chinese Journal of Nursing,2018,53(2):247-250.
[15]李智,田永明,李霞,等.某医院ICU护士谵妄评估现状及障碍因素调查.中国护理管理,2016,16(6):843-848.Li Z,Tian YM,Li X,et al.Delirium assessment in Intensive Care Unit in one hospital:current practice and perceived barriers.Chinese Nursing Management,2016,16(6):843-848.
[16]孙建华,郭海凌,孙丹丹,等.重症患者谵妄评估的现状调查及影响因素分析.中华护理杂志,2018,53(1):17-21.Sun JH,Guo HL,Sun DD,et al.Analysis on risk factors and incidence of delirium subtypes patients in ICU.Chinese Journal of Nursing,2018,53(1):17-21.
[17]Hosker C,Ward D.Hypoactive delirium.BMJ,2017(357):j2047.
[18]王春立,吴瑛,黄洁,等.ICU谵妄亚型发生率及风险因素分析.护理研究,2011,25(33):3058-3061.Wang CL,Wu Y,Huang J,et al.Analysis on risk factors and incidence of delirium subtypes patients in ICU.Chinese Nursing Research,2011,25(33):3058-3061.
[19]Baron R,Binder A,Biniek R,et al.Evidence and consensus based guideline for the management of delirium,analgesia,and sedation in intensive care medicine.Revision 2015(DAS-Guideline 2015)-short version.German Medical Science:GMS e-Journal,2015(13):19.
[20]李云,贺婷,吴文娟.中文版PR E-DELIRIC谵妄预测模型的信度和效度研究.护士进修杂志,2015(15):1356-1359.Li Y,He T,Wu WJ.Study for the reliability and validity of Chinese version PRE-DELIRICdelirium prediction model.Journal of Nurses Training,2015(15):1356-1359.
[21]莫苗苗,张小培,叶日春,等.ICU护士对疼痛、躁动和谵妄管理的知信行调查.中国护理管理,2018,18(2):253-259.Mo MM,Zhang XP,Ye RC,et al.Knowledge,attitudes and practices on pain,agitation,and delirium among nurses in Intensive Care Unit.Chinese Nursing Management,2018,18(2):253-259.
[22]Sessler CN,Varney K.Patient-focused sedation and analgesia in the ICU.Chest,2008,133(2):552-565.
[23]Kamdar BB,Niessen T,Colantuoni E,et al.Delirium transitions in the medical ICU:exploring the role of sleep quality and other factors.Critical Care Medicine,2015,43(1):135-141.
[24]Rozycki A,Jarrell AS,Kruer RM,et al.Feasibility of a nurse-managed pain,agitation,and delirium protocol in the surgical Intensive Care Unit.Critical Care Nurse,2017,37(6):24.
[25]Mansouri P,Javadpour S,Zand F,et al.Implementation of a protocol for integrated management of pain,agitation,and delirium can improve clinical outcomes in the intensive care unit:a randomized clinical trial.Journal of Critical Care,2013,28(6):918-922.
[26]Bucknall TK,Manias E,Presneill JJ.Arandomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit.Critical Care Medicine,2008,36(5):1444-1450.
[27]Balas M,Buckingham R,Braley T,et al.Extending the ABCDE bundle to the post-Intensive Care Unit setting.Journal of Gerontological Nursing,2013,39(8):39-51.
[28]诸国萍.ABCDE集束化管理方法在预防ICU获得性谵妄病人中的应用与护理.全科护理,2017,15(3):310-312.Zhu GP.The application and nursing of ABCDEcluster management method in preventing ICUacquired delirium.Chinese General Nursing,2017,15(3):310-312.
[29]Vincent JL,Shehabi Y,Walsh TS,et al.Comfort and patient-centred care without excessive sedation:the eCASH concept.Intensive Care Medicine,2016,42(6):962-971.
[30]王滨,张竹,马朋林.机械通气患者镇痛/镇静策略优化的研究进展.解放军医学杂志,2017,42(2):122-127.Wang B,Zhang Z,Ma PL.Updates in optimizing analgesia/sedation strategy for mechanically ventilated patients.Medical Journal of Chinese PLA,2017,42(2):122-127.
[31]Schilling D,Leicht K,Beilenhoff U,et al.Impact of S3 training courses"Sedation and Emergency Management in Endoscopy for Endoscopy Nurses and Assisting Personnel"on the process and st r uct u re qualit y in gastroenterological endoscopy in practices and clinics-results of a nationwide survey.Zeitschrift Fur Gastroenterologie,2013,51(7):619-627.
[32]Kotfis K,Zeganbarańska M,?ukowski M,et al.Multicenter assessment of sedation and delirium practices in the intensive care units in Poland-is this common practice in Eastern Europe?.BMC Anesthesiology,2017,17(1):120.
[33]Devlin JW,Fong JJ,Howard EP,et al.Assessment of delirium in the intensive care unit:nursing practices and perceptions.American Journal of Critical Care,2008,17(6):555.
[2]Hansen-Flaschen JH,Brazinsky S,Basile C,et al.Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure:a national survey.JAMA,1991,266(20):2870-2875.
[3]Balzer F,Wei?B,Kumpf O,et al.Early deep sedation is associated with decreased in-hospital and two-year follow-up survival.Critical Care,2015,19(1):1-9.
[4]Shehabi Y,Bellomo R,Reade MC,et al.Early intensive care sedation predicts long-term mortality in ventilated critically ill patients.American Journal of Respiratory&Critical Care Medicine,2012,186(8):724-731.
[5]Brown CH,Azman AS,Gottschalk A,et al.Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair//中国中西医结合麻醉学会[csia]年会暨全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会,2015:977-980.Brown CH,Azman AS,Gottschalk A,et al.Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair//The Annual Meeting for Chinese socity of Chinese and Western Integrative Anesthesia and National symposium on integrated Chinese and western medicine in anesthesia,Jiangsu provincial association of Chinese and western medicine and the establishment of the professional committee of anesthesia conference,2015:977-980.
[6]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit.Critical Care Medicine,2013,41(1):263-306.
[7]中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南.中华重症医学电子杂志:网络版,2018(2):1.Society of Critical Care Medicine,Chinese Medical Association.Guidelines of analgesia and sedation for Chinese adults.Chinese Journal of Critical Care Medicine(Electronic Editon),2018(2):1.
[8]Chanques G,Pohlman A,Kress JP,et al.Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report.Critical Care,2014,18(5):R160.
[9]Severgnini P,Pelosi P,Contino E,et al.Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients:prospective,observational study.Journal of Intensive Care,2016,4(1):68.
[10]李青栋,万献尧,谷春梅,等.中文版ICU患者疼痛观察工具在机械通气患者应用的信度与效度.中华内科杂志,2012,51(8):642-643.Li QD,Wan XY,Gu CM,et al.Validity and reliabity of pain observation tool for ICU patients in machinery ventilates patient(Chinese version).Chinese Journal of Internal Medicine,2012,51(8):642-643.
[11]陈杰,杨晓红,路潜,等.中文版重症监护疼痛观察工具在非气管插管患者中应用的信效度研究.中华护理杂志,2015,50(9):1132-1136.Chen J,Yang XH,Lu Q,et al.Psychometic properties analysis of ICU Pain Observation Tool in Patients without Tracheal Intubation(Chinese Version).Chinese Journal of Nursing,2015,50(9):1132-1136.
[12]张盼,张春华,朱小平.应用重症监护疼痛观察工具评估重症监护患者疼痛的Meta分析.中华现代护理杂志,2016,22(4):526-530.Zhang P,Zhang CH,Zhu XP.Application of CPOT on pain evaluation in ICU critical patients:a Meta-analysis.Journal of Modern Nursing,2016,22(4):526-530.
[13]周丹,孙运波,姜文彬,等.ICU医护人员对疼痛、躁动和谵妄管理循证知识的认知调查.护理管理杂志,2014,14(11):780-782.Zhou D,Sun YB,Jiang WB,et al.Investigation of doctors'and nurses'perceptions towards the evidence-based management of pain,agitation and delirium.Journal of Nursing Administration,2014,14(11):780-782.
[14]朱明明,刘芳,王冉.躁动镇静评分在重症患者中应用的研究进展.中华护理杂志,2018,53(2):247-250.Zhu MM,Liu F,Wang R.The application of Agitation and Sedation Scale in critical patients.Chinese Journal of Nursing,2018,53(2):247-250.
[15]李智,田永明,李霞,等.某医院ICU护士谵妄评估现状及障碍因素调查.中国护理管理,2016,16(6):843-848.Li Z,Tian YM,Li X,et al.Delirium assessment in Intensive Care Unit in one hospital:current practice and perceived barriers.Chinese Nursing Management,2016,16(6):843-848.
[16]孙建华,郭海凌,孙丹丹,等.重症患者谵妄评估的现状调查及影响因素分析.中华护理杂志,2018,53(1):17-21.Sun JH,Guo HL,Sun DD,et al.Analysis on risk factors and incidence of delirium subtypes patients in ICU.Chinese Journal of Nursing,2018,53(1):17-21.
[17]Hosker C,Ward D.Hypoactive delirium.BMJ,2017(357):j2047.
[18]王春立,吴瑛,黄洁,等.ICU谵妄亚型发生率及风险因素分析.护理研究,2011,25(33):3058-3061.Wang CL,Wu Y,Huang J,et al.Analysis on risk factors and incidence of delirium subtypes patients in ICU.Chinese Nursing Research,2011,25(33):3058-3061.
[19]Baron R,Binder A,Biniek R,et al.Evidence and consensus based guideline for the management of delirium,analgesia,and sedation in intensive care medicine.Revision 2015(DAS-Guideline 2015)-short version.German Medical Science:GMS e-Journal,2015(13):19.
[20]李云,贺婷,吴文娟.中文版PR E-DELIRIC谵妄预测模型的信度和效度研究.护士进修杂志,2015(15):1356-1359.Li Y,He T,Wu WJ.Study for the reliability and validity of Chinese version PRE-DELIRICdelirium prediction model.Journal of Nurses Training,2015(15):1356-1359.
[21]莫苗苗,张小培,叶日春,等.ICU护士对疼痛、躁动和谵妄管理的知信行调查.中国护理管理,2018,18(2):253-259.Mo MM,Zhang XP,Ye RC,et al.Knowledge,attitudes and practices on pain,agitation,and delirium among nurses in Intensive Care Unit.Chinese Nursing Management,2018,18(2):253-259.
[22]Sessler CN,Varney K.Patient-focused sedation and analgesia in the ICU.Chest,2008,133(2):552-565.
[23]Kamdar BB,Niessen T,Colantuoni E,et al.Delirium transitions in the medical ICU:exploring the role of sleep quality and other factors.Critical Care Medicine,2015,43(1):135-141.
[24]Rozycki A,Jarrell AS,Kruer RM,et al.Feasibility of a nurse-managed pain,agitation,and delirium protocol in the surgical Intensive Care Unit.Critical Care Nurse,2017,37(6):24.
[25]Mansouri P,Javadpour S,Zand F,et al.Implementation of a protocol for integrated management of pain,agitation,and delirium can improve clinical outcomes in the intensive care unit:a randomized clinical trial.Journal of Critical Care,2013,28(6):918-922.
[26]Bucknall TK,Manias E,Presneill JJ.Arandomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit.Critical Care Medicine,2008,36(5):1444-1450.
[27]Balas M,Buckingham R,Braley T,et al.Extending the ABCDE bundle to the post-Intensive Care Unit setting.Journal of Gerontological Nursing,2013,39(8):39-51.
[28]诸国萍.ABCDE集束化管理方法在预防ICU获得性谵妄病人中的应用与护理.全科护理,2017,15(3):310-312.Zhu GP.The application and nursing of ABCDEcluster management method in preventing ICUacquired delirium.Chinese General Nursing,2017,15(3):310-312.
[29]Vincent JL,Shehabi Y,Walsh TS,et al.Comfort and patient-centred care without excessive sedation:the eCASH concept.Intensive Care Medicine,2016,42(6):962-971.
[30]王滨,张竹,马朋林.机械通气患者镇痛/镇静策略优化的研究进展.解放军医学杂志,2017,42(2):122-127.Wang B,Zhang Z,Ma PL.Updates in optimizing analgesia/sedation strategy for mechanically ventilated patients.Medical Journal of Chinese PLA,2017,42(2):122-127.
[31]Schilling D,Leicht K,Beilenhoff U,et al.Impact of S3 training courses"Sedation and Emergency Management in Endoscopy for Endoscopy Nurses and Assisting Personnel"on the process and st r uct u re qualit y in gastroenterological endoscopy in practices and clinics-results of a nationwide survey.Zeitschrift Fur Gastroenterologie,2013,51(7):619-627.
[32]Kotfis K,Zeganbarańska M,?ukowski M,et al.Multicenter assessment of sedation and delirium practices in the intensive care units in Poland-is this common practice in Eastern Europe?.BMC Anesthesiology,2017,17(1):120.
[33]Devlin JW,Fong JJ,Howard EP,et al.Assessment of delirium in the intensive care unit:nursing practices and perceptions.American Journal of Critical Care,2008,17(6):555.