镇静镇痛集束护理对ICU气管插管患者谵妄的影响
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摘要
目的探讨镇静镇痛集束护理策略对ICU气管插管患者谵妄的影响。方法依据便利抽样法,选取2017年1—8月转入ICU的80例行气管插管患者,作为集束化组,在常规护理的同时进行规范化镇静镇痛集束护理措施。另取同期转入ICU的80例气管插管患者,作为对照组,行常规护理。记录患者性别、年龄、疾病诊断例数分布、使用镇静镇痛药的情况、急性生理和慢性健康评分(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)、ICU住院时间、机械通气时间、谵妄发生率、谵妄类型(安静型、躁动型或混合型)及持续时间。结果 2组患者的性别构成、平均年龄、疾病诊断例数分布、使用镇静镇痛药的情况、APACHEⅡ评分、ICU住院时间和机械通气时间比较,差异均无统计学意义(P>0.05);集束化组谵妄的发生率及谵妄的构成类型与对照组相比,差异无统计学意义(P>0.05),但谵妄持续时间显著缩短(P<0.05)。结论镇静镇痛集束的应用可有效降低气管插管患者的谵妄持续时间,可能对改善预后起到积极作用。
Objective To explore the effect of bundle nursing of sedation and analgesia on delirium of trachea intubation patients in ICU. Methods With convenient sampling, 80 trachea intubation patients from January to August 2017 were enrolled in the observation group, in which bundle nursing of standardized sedation and analgesia was performed in addition to conventional nursing and another 80 trachea intubation patients in the control group, in which convention nursing was performed. General information of the patients, number distribution of disease diagnosis, medication of sedation and analgesia, Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) score, stay of length in ICU, duration of mechanical ventilation, incidence, type and duration of delirium in the 2 groups were recorded and compared. Results There was no statistical significance regarding to patients ' general information,number distribution of disease diagnosis, medication of sedation and analgesia, APACHE Ⅱ score, stay of length in ICU and duration of mechanical ventilation in the 2 groups(P>0.05). The incidence and type of delirium showed no statistical significance in the 2 groups(P>0.05) but the duration of delirium in the observation group was obviously shortened( P<0.05). Conclusion Bundle nursing of sedation and analgesia is effective for shortening the duration of delirium for trachea intubation patients in ICU and plays a positive role in the prognosis of the patients.
Objective To explore the effect of bundle nursing of sedation and analgesia on delirium of trachea intubation patients in ICU. Methods With convenient sampling, 80 trachea intubation patients from January to August 2017 were enrolled in the observation group, in which bundle nursing of standardized sedation and analgesia was performed in addition to conventional nursing and another 80 trachea intubation patients in the control group, in which convention nursing was performed. General information of the patients, number distribution of disease diagnosis, medication of sedation and analgesia, Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) score, stay of length in ICU, duration of mechanical ventilation, incidence, type and duration of delirium in the 2 groups were recorded and compared. Results There was no statistical significance regarding to patients ' general information,number distribution of disease diagnosis, medication of sedation and analgesia, APACHE Ⅱ score, stay of length in ICU and duration of mechanical ventilation in the 2 groups(P>0.05). The incidence and type of delirium showed no statistical significance in the 2 groups(P>0.05) but the duration of delirium in the observation group was obviously shortened( P<0.05). Conclusion Bundle nursing of sedation and analgesia is effective for shortening the duration of delirium for trachea intubation patients in ICU and plays a positive role in the prognosis of the patients.
引文
[1]Anon.American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium in Older Adults[J].J Am Geriatr Soc,2015,63(1):142-150.DOI:10.1111/jgs.13281.
[2]Klein K P,Zaal I J,Spitoni C,et al.The Attributable Mortality of Delirium in Critically Ill Patients:Prospective Cohort Study[J].BMJ,2014,349:6652.DOI:10.1136/bmj.g6652.
[3]Pandharipande P P,Girard T D,Jackson J C,et al.Longterm Cognitive Impairment after Critical Illness[J].N Engl J Med,2013,369(14):1306-1316.DOI:10.1056/NEJMoa1301372.
[4]Balas M,Buckingham R,Braley T,et al.Extending the ABCDE Bundle to the Post-Intensive Care Unit Setting[J].J Gerontol Nurs,2013,39(8):39-51.DOI:10.3928/00989134-20130530-06.
[5]Balas M C,Vasilevskis E E,Burke W J,et al.Critical Care Nurses’Role in Implementing the“ABCDE Bundle”into Practice[J].Crit Care Nurse,2012,32(2):35-47.DOI:10.4037/ccn2012229.
[6]李钰,金献冠,胡明磊,等.急性生理和慢性健康评分Ⅱ、急性肾小管坏死个体病情严重性指数评分在急性肾损伤中的应用价值[J].中国基层医药,2015(5):685-688.DOI:10.3760/cma.j.issn.1008-6706.2015.05.016.
[7]Wang W,Li H L,Wang D X,et al.Haloperidol Prophylaxis Decreases Delirium Incidence in Elderly Patients after Noncardiac Surgery:A Randomized Controlled Trial[J].Crit Care Med,2012,40(3):731-739.DOI:10.1097/CCM.0b013e3182376e4f.
[8]邵亚娣,朱建华,林郁青.意识模糊评估法在ICU谵妄早期评估及干预中的应用研究[J].护士进修杂志,2017,32(5):441-444.DOI:10.16821/j.cnki.hsjx.2017.05.018.
[9]Esteban A,Anzueto A,Alía I,et al.How is Mechanical Ventilation Employed in the Intensive Care Unit?An International Utilization Review[J].Am J Respir Crit Care Med,2000,161(5):1450-1458.DOI:10.1164/ajrccm.161.5.9902018.
[10]Yang L,Ye L,Zheng Z,et al.Evaluation of the Effectiveness and Safety of the Awakening and Breathing Coordination,Delirium Monitoring/Management,and Early Exercise/Mobility Bundle:Several Confounders to Be Considered[J].Crit Care Med,2014,42(10):680-681.DOI:10.1097/CCM.0000000000000492.
[11]Sharma A,Malhotra S,Grover S,et al.Incidence,Prevalence,Risk Factor and Outcome of Delirium in Intensive Care Unit:A Study From India[J].Gen Hosp Psychiatry,2012,34(6):639-646.DOI:10.1016/j.genhosppsych.2012.06.009.
[12]Page V J,Kurth T.Delirium on the Intensive Care Unit[J].BMJ,2014,349:7265.DOI:10.1136/bmj.g7265.
[13]Payen J F,Chanques G,Mantz J,et al.Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients:A Prospective Multicenter Patient-based Study[J].Anesthesiology,2007,106(4):687-695.DOI:10.1097/01.anes.0000264747.09017.da.
[14]Balas M C,Vasilevskis E E,Olsen K M,et al.Effectiveness and Safety of the Awakening and Breathing Coordination,Delirium Monitoring/management,and Early Exercise/mobility Bundle[J].Crit Care Med,2014,42(5):1024-1036.DOI:10.1097/CCM.0000000000000129.
[15]孙丹丹,王瑞,芦秀燕,等.ICU患者谵妄持续时间及其影响因素的研究[J].中华护理杂志,2017,52(10):1168-1172.DOI:10.3761/j.issn.0254-1769.2017.10.003.
[16]Pandharipande P,Banerjee A,Mc Grane S,et al.Liberation and Animation for Ventilated ICU Patients:the ABCDE Bundle for the Back-end of Critical Care[J].Crit Care,2010,14(3):157.DOI:10.1186/cc8999.
[17]赵英娜,刘华平.ABCDE镇静镇痛集束预防ICU机械通气患者谵妄和乏力的研究进展[J].中国护理管理,2015,15(7):876-880.DOI:10.3969/j.issn.1672-1756.2015.07.030.
[18]Davidson J E,Harvey M A,Bemis-Dougherty A,et al.Implementation of the Pain,Agitation,and Delirium Clinical Practice Guidelines and Promoting Patient Mobility to Prevent Post-intensive Care Syndrome[J].Crit Care Med,2013,41(9 Suppl 1):136-145.DOI:10.1097/CCM.0b013e3182a24105.
[2]Klein K P,Zaal I J,Spitoni C,et al.The Attributable Mortality of Delirium in Critically Ill Patients:Prospective Cohort Study[J].BMJ,2014,349:6652.DOI:10.1136/bmj.g6652.
[3]Pandharipande P P,Girard T D,Jackson J C,et al.Longterm Cognitive Impairment after Critical Illness[J].N Engl J Med,2013,369(14):1306-1316.DOI:10.1056/NEJMoa1301372.
[4]Balas M,Buckingham R,Braley T,et al.Extending the ABCDE Bundle to the Post-Intensive Care Unit Setting[J].J Gerontol Nurs,2013,39(8):39-51.DOI:10.3928/00989134-20130530-06.
[5]Balas M C,Vasilevskis E E,Burke W J,et al.Critical Care Nurses’Role in Implementing the“ABCDE Bundle”into Practice[J].Crit Care Nurse,2012,32(2):35-47.DOI:10.4037/ccn2012229.
[6]李钰,金献冠,胡明磊,等.急性生理和慢性健康评分Ⅱ、急性肾小管坏死个体病情严重性指数评分在急性肾损伤中的应用价值[J].中国基层医药,2015(5):685-688.DOI:10.3760/cma.j.issn.1008-6706.2015.05.016.
[7]Wang W,Li H L,Wang D X,et al.Haloperidol Prophylaxis Decreases Delirium Incidence in Elderly Patients after Noncardiac Surgery:A Randomized Controlled Trial[J].Crit Care Med,2012,40(3):731-739.DOI:10.1097/CCM.0b013e3182376e4f.
[8]邵亚娣,朱建华,林郁青.意识模糊评估法在ICU谵妄早期评估及干预中的应用研究[J].护士进修杂志,2017,32(5):441-444.DOI:10.16821/j.cnki.hsjx.2017.05.018.
[9]Esteban A,Anzueto A,Alía I,et al.How is Mechanical Ventilation Employed in the Intensive Care Unit?An International Utilization Review[J].Am J Respir Crit Care Med,2000,161(5):1450-1458.DOI:10.1164/ajrccm.161.5.9902018.
[10]Yang L,Ye L,Zheng Z,et al.Evaluation of the Effectiveness and Safety of the Awakening and Breathing Coordination,Delirium Monitoring/Management,and Early Exercise/Mobility Bundle:Several Confounders to Be Considered[J].Crit Care Med,2014,42(10):680-681.DOI:10.1097/CCM.0000000000000492.
[11]Sharma A,Malhotra S,Grover S,et al.Incidence,Prevalence,Risk Factor and Outcome of Delirium in Intensive Care Unit:A Study From India[J].Gen Hosp Psychiatry,2012,34(6):639-646.DOI:10.1016/j.genhosppsych.2012.06.009.
[12]Page V J,Kurth T.Delirium on the Intensive Care Unit[J].BMJ,2014,349:7265.DOI:10.1136/bmj.g7265.
[13]Payen J F,Chanques G,Mantz J,et al.Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients:A Prospective Multicenter Patient-based Study[J].Anesthesiology,2007,106(4):687-695.DOI:10.1097/01.anes.0000264747.09017.da.
[14]Balas M C,Vasilevskis E E,Olsen K M,et al.Effectiveness and Safety of the Awakening and Breathing Coordination,Delirium Monitoring/management,and Early Exercise/mobility Bundle[J].Crit Care Med,2014,42(5):1024-1036.DOI:10.1097/CCM.0000000000000129.
[15]孙丹丹,王瑞,芦秀燕,等.ICU患者谵妄持续时间及其影响因素的研究[J].中华护理杂志,2017,52(10):1168-1172.DOI:10.3761/j.issn.0254-1769.2017.10.003.
[16]Pandharipande P,Banerjee A,Mc Grane S,et al.Liberation and Animation for Ventilated ICU Patients:the ABCDE Bundle for the Back-end of Critical Care[J].Crit Care,2010,14(3):157.DOI:10.1186/cc8999.
[17]赵英娜,刘华平.ABCDE镇静镇痛集束预防ICU机械通气患者谵妄和乏力的研究进展[J].中国护理管理,2015,15(7):876-880.DOI:10.3969/j.issn.1672-1756.2015.07.030.
[18]Davidson J E,Harvey M A,Bemis-Dougherty A,et al.Implementation of the Pain,Agitation,and Delirium Clinical Practice Guidelines and Promoting Patient Mobility to Prevent Post-intensive Care Syndrome[J].Crit Care Med,2013,41(9 Suppl 1):136-145.DOI:10.1097/CCM.0b013e3182a24105.