ICU患者亚谵妄护理方案的构建及效果评价研究

doi:10.3761/j.issn.2096-7446.2025.02.002

摘要/Abstract

摘要：

目的构建基于最佳证据的ICU患者亚谵妄护理方案，并探讨其临床应用效果。方法在文献分析的基础上构建ICU患者亚谵妄护理方案。采用便利抽样法，选取2023年1月—5月于山东省某三级甲等医院重症医学科收治的58例清醒患者作为试验组，在常规护理基础上实施基于最佳证据的亚谵妄护理方案；将2022年8月—12月收治的61例清醒患者作为对照组，予以常规护理。比较两组患者谵妄和亚谵妄发生率、ICU住院时长及出科时认知功能评分。结果方案实施后，试验组患者亚谵妄发生率为16.07%，对照组为34.55%，差异有统计学意义（P<0.05）；试验组患者谵妄发生率为7.14%，对照组为20.00%，差异有统计学意义（P<0.05）；试验组患者ICU住院时长为（6.02±4.00） d，对照组为（6.44±4.45） d，差异无统计学意义（P>0.05）；试验组患者出ICU时认知功能评分为（9.09±0.67）分，对照组为（8.31±1.09）分，差异有统计学意义（P<0.001）。结论基于最佳证据的ICU患者亚谵妄护理方案有助于降低患者谵妄和亚谵妄的发生率、改善其认知功能。

关键词: 重症监护病房, 亚谵妄, 早期干预, 循证护理研究

Abstract:

Objective To establish a subdelirium nursing program for ICU patients based on the best evidence，and explore its clinical application effect. Methods Based on the literature analysis，the subdelirium nursing program for ICU patients was established. Convenience sampling method was used to select 58 patients who were admitted to the intensive care unit in a tertiary class A hospital in Shandong Province from January to May 2023 as the experimental group，who were given the subdelirium nursing program based on the best evidence. Another 61 patients treated from August to December 2022 were taken as the control group and given routine nursing. The delirium rate and subdelirium rate，length of hospital stay and cognitive function score were compared between the two groups. Results After the intervention，the incidence of subdelirium was 16.07% in experimental group and 34.55% in control group，the difference was statistically significant（P<0.05）. The incidence of delirium was 7.14% in experimental group and 20.00% in control group，the difference was statistically significant（P<0.05）. The length of hospital stay was（6.02±4.00） days in experimental group and（6.44±4.45） days in control group，with no statistical significance（P>0.05）. The cognitive function score of the experimental group was（9.09±0.67） points and that of the control group was（8.31±1.09） points，the difference was statistically significant（P<0.001）. Conclusion The subdelirium nursing program based on the best evidence for ICU patients can help to reduce the incidence of delirium，subdelirium and enhance their cognitive function.

Key words: Intensive Care Unit, Subdelirium, Early Intervention, Evidence-Based Nursing

李晓静, 张晓旭, 王飞, 刘晓晓, 孟宪珍, 尚文华. ICU患者亚谵妄护理方案的构建及效果评价研究[J]. 中华急危重症护理杂志, 2025, 6(2): 139-145.

LI Xiaojing, ZHANG Xiaoxu, WANG Fei, LIU Xiaoxiao, MENG Xianzhen, SHANG Wenhua. Construction and effect evaluation of subdelirium nursing program for ICU patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(2): 139-145.

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参考文献 32

[1]	吴清清, 杨红萍, 宁丽, 等. 老年骨折患者谵妄预防及管理循证护理审查指标的制定及障碍因素分析[J]. 护理管理杂志, 2021, 21(4):229-233,264.
	Wu QQ, Yang HP, Ning L, et al. Formulation of evidence-based nursing review indexes for the prevention and management of delirium in elderly fracture patients and analysis its obstacle factors[J]. J Nurs Adm, 2021, 21(4):229-233,264.
[2]	汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识[J]. 中华内科杂志, 2019, 58(2):108-118.
	Tang B, Wang XT, Chen WJ, et al. Experts consensus on the management of delirium in critically ill patients[J]. Chin J Intern Med, 2019, 58(2):108-118. doi: 10.3760/cma.j.issn.0578-1426.2019.02.007 pmid: 30704197
[3]	Boettger S, Nuñez DG, Meyer R, et al. Subsyndromal delirium in the intensive care setting:phenomenological characteristics and discrimination of subsyndromal delirium versus no and full-syndromal delirium[J]. Palliat Support Care, 2018, 16(1):3-13. doi: 10.1017/S1478951517000104 pmid: 28262089
[4]	苗凤凤, 单信芝, 孙黎惠, 等. ICU病人亚谵妄综合征发生现状调查及原因分析[J]. 全科护理, 2020, 18(20):2479-2483.
	Miao FF, Shan XZ, Sun LH, et al. The status quo survey and causative analysis of ICU patients with subdelirium syndrome[J]. Chin Gen Pract Nurs, 2020, 18(20):2479-2483.
[5]	Yamada C, Iwawaki Y, Harada K, et al. Frequency and risk factors for subsyndromal delirium in an intensive care unit[J]. Intensive Crit Care Nurs, 2018, 47:15-22.
[6]	李雪苹, 王磊, 张淮, 等. Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的构建与效果验证[J]. 中华护理杂志, 2022, 57(8):950-957. doi: 10.3761/j.issn.0254-1769.2022.08.009
	Li XP, Wang L, Zhang H, et al. Construction and evaluation of a risk prediction model of postoperative delirium in patients with Stanford type A aortic dissection[J]. Chin J Nurs, 2022, 57(8):950-957. doi: 10.3761/j.issn.0254-1769.2022.08.009
[7]	Li X, Zhang LN, Gong F, et al. Incidence and risk factors for delirium in older patients following intensive care unit admission:a prospective observational study[J]. J Nurs Res, 2020, 28(4):e101.
[8]	程晓雪, 石萍, 刘春兰. 急诊创伤患者亚谵妄发生预测模型的构建及验证研究[J]. 中华急危重症护理杂志, 2021, 2(6):485-490.
	Cheng XX, Shi P, Liu CL. Construction and validation of prediction model of subsyndromal delirium in emergency trauma patients[J]. Chin J Emerg Crit Care Nurs, 2021, 2(6):485-490.
[9]	Klimiec-Moskal E, LIS A, Pera J, et al. Subsyndromal delirium is associated with poor functional outcome after ischaemic stroke[J]. Eur J Neurol, 2019, 26(6):927-934. doi: 10.1111/ene.13912 pmid: 30674083
[10]	李真, 李奇, 李尊柱, 等. ICU患者亚谵妄综合征患病率及危险因素的系统评价[J]. 中华护理杂志, 2020, 55(2):288-293. doi: 10.3761/j.issn.0254-1769.2020.02.023
	Li Z, Li Q, Li ZZ, et al. Prevalence and risk factors of subsyndromal delirium among adult intensive care unit patients:a systematic review[J]. Chin J Nurs, 2020, 55(2):288-293. doi: 10.3761/j.issn.0254-1769.2020.02.023
[11]	刘桂英, 徐克珮, 王阳阳, 等. 成人ICU患者谵妄与亚谵妄综合征非药物管理的证据总结[J]. 中国护理管理, 2021, 21(6):880-886.
	Liu GY, Xu KP, Wang YY, et al. Non-drug management of delirium and subsyndromal delirium in adult intensive care unit patients:an evidence summary[J]. Chin Nurs Manag, 2021, 21(6):880-886.
[12]	焦瑞娜, 邢林波, 张喜艳, 等. 基于HELP模式的骨科老年病人术后谵妄中医联合干预方案的构建与应用[J]. 护理研究, 2023, 37(24):4492-4497.
	Jiao RN, Xing LB, Zhang XY, et al. Construction and application of TCM combined intervention program for postoperative delirium in orthopedic elderly patients based on HELP model[J]. Chin Nurs Res, 2023, 37(24):4492-4497.
[13]	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[J]. 中华危重病急救医学, 2018, 30(6):497-514.
	Critical Care Medicine Branch of Chinese Medical Associa-tion. Guidelines for analgesia and sedation treatment in intensive care unit of Chinese adults[J]. Chin Crit Care Med, 2018, 30(6):497-514.
[14]	张莹莹, 张广清, 李佳雨, 等. 基于循证构建ICU亚谵妄综合征早期识别及管理方案[J]. 护理学报, 2022, 29(17):7-12.
	Zhang YY, Zhang GQ, Li JY, et al. Construction of early identification and management scheme of subdelirium syndrome in ICU based on evidence[J]. J Nurs China, 2022, 29(17):7-12.
[15]	李九红, 黄伶智, 周艳红, 等. ICU成人患者谵妄预防及管理策略的最佳证据总结[J]. 护士进修杂志, 2022, 37(5):439-445.
	Li JH, Huang LZ, Zhou YH, et al. Summary of the best evidence of delirium prevention and management strategies for adult patients in ICU[J]. J Nurses Train, 2022, 37(5):439-445.
[16]	Seo Y, Lee HJ, Ha EJ, et al. 2021 KSCCM clinical practice guidelines for pain,agitation,delirium,immobility,and sleep disturbance in the intensive care unit[J]. Acute Crit Care, 2022, 37(1):1-25.
[17]	Burry LD, Cheng W, Williamson DR, et al. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients:a systematic review and network meta-analysis[J]. Intensive Care Med, 2021, 47(9):943-960. doi: 10.1007/s00134-021-06490-3 pmid: 34379152
[18]	纪媛媛, 王军, 欧梦仙, 等. 神经外科重症患者谵妄综合干预方案的构建[J]. 中国护理管理, 2023, 23(10):1569-1574.
	Ji YY, Wang J, Ou MX, et al. Construction of a comprehensive intervention program for delirium in severe neurosurgical patients[J]. Chin Nurs Manag, 2023, 23(10):1569-1574.
[19]	何彬, 刘文婷, 王钰莹, 等. ICU成人患者谵妄防治家庭参与式多感官刺激方案的构建[J]. 护理学杂志, 2022, 37(22):27-31.
	He B, Liu WT, Wang YY, et al. Construction of a family participatory multisensory stimulation program for management of delirium for ICU adults patients[J]. J Nurs Sci, 2022, 37(22):27-31.
[20]	纪媛媛, 王军, 俞洁, 等. 神经外科ICU患者身体约束分级管理方案的构建及应用[J]. 中华护理杂志, 2021, 56(3):342-346. doi: 10.3761/j.issn.0254-1769.2021.03.004
	Ji YY, Wang J, Yu J, et al. Construction and application of a hierarchical management scheme of physical restraint for ICU patients in neurosurgery[J]. Chin J Nurs, 2021, 56(3):342-346. doi: 10.3761/j.issn.0254-1769.2021.03.004
[21]	中华医学会神经病学分会神经心理与行为神经病学学组. 综合医院谵妄诊治中国专家共识(2021)[J]. 中华老年医学杂志, 2021, 40(10):1226-1233.
	Neuropsychology and Behavioral Neurology Group of Neurol-ogy Branch of Chinese Medical Association. Chinese experts consensus on diagnosis and treatment of delirium in general hospital(2021)[J]. Chin J Geriatr, 2021, 40(10):1226-1233.
[22]	Registered Nurses’ Association of Ontario. (2016). Delirium,dementia,and depression in older adults:assessment and care (2nd ed.)[M]. Toronto, ON: Registered Nurses’ Association of Ontario.
[23]	国家老年疾病临床医学研究中心湘雅, 中南大学湘雅医院, JBI湘雅循证实践与健康卫生保健创新中心, 等. 多参数监护仪临床警报管理实践指南(2020版)简版[J]. 中国护理管理, 2021, 21(5):758-765.
	National Clinical Research Center of Geriatric Disease(Xiangya), Xiangya Hospital Central South University, Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation:a JBI Affiliated Group. et al. Practice recommendation for clinical alarm management of multi-parameter monitors in 2020(simplified version)[J]. Chin Nurs Manag, 2021, 21(5):758-765.
[24]	Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients:validity and reliability of the confusion assessment method for the intensive care unit(CAM-ICU)[J]. JAMA, 2001, 286(21):2703-2710.
[25]	Merigian KS, Hedges JR, Roberts JR, et al. Use of abbreviated mental status examination in the initial assessment of overdose patients[J]. Arch Emerg Med, 1988, 5(3):139-145. pmid: 3178971
[26]	王慧云, 郭安娜. 简易精神状态检查量表的汉化及在脑外伤病人中的信效度研究[J]. 护理研究, 2020, 34(24):4488-4490.
	Wang HY, Guo AN. Chinese localization of Abbreviated Mental State Examination Scale and its reliability and validity in patients with brain trauma[J]. Chin Nurs Res, 2020, 34(24):4488-4490.
[27]	蒋雅琼, 刘颖, 王颖, 等. ICU亚谵妄高危患者综合干预方案的制订及实践[J]. 中国医药科学, 2021, 11(13):199-202.
	Jiang YQ, Liu Y, Wang Y, et al. Formulation and practice of comprehensive intervention plan for high-risk ICU patients with subdelirium[J]. China Med Pharm, 2021, 11(13):199-202.
[28]	李静逸, 许惠芬, 宋春梅, 等. ICU亚谵妄患者认知功能干预方案的构建及应用效果分析[J]. 中国护理管理, 2021, 21(6):855-861.
	Li JY, Xu HF, Song CM, et al. The development and applica-tion of cognitive function intervention program in ICU pa-tients with subsyndromal delirium[J]. Chin Nurs Manag, 2021, 21(6):855-861.
[29]	崔薇, 张山, 吴瑛. 住院老年病人生活干预方案预防谵妄效果的Meta分析[J]. 护理研究, 2024, 38(3):488-494.
	Cui W, Zhang S, Wu Y. Effect of hospital elderly life program on the prevention of delirium:a Meta-analysis[J]. Chin Nurs Res, 2024, 38(3):488-494.
[30]	Xu CH, Chen ZZ, Zhang LX, et al. Systematic review and meta-analysis on the incidence of delirium in intensive care unit inpatients after cognitive exercise intervention[J]. Ann Pal-liat Med, 2022, 11(2):663-672.
[31]	Boehm LM, Jones AC, Selim AA, et al. Delirium-related distress in the ICU:a qualitative meta-synthesis of patient and family perspectives and experiences[J]. Int J Nurs Stud, 2021, 122:104030.
[32]	焦雪萍, 刘瑞云, 李文娟, 等. 家庭干预在ICU患者谵妄防治中的研究进展[J]. 中华急危重症护理杂志, 2022, 3(2):173-176.
	Jiao XP, Liu RY, Li WJ, et al. Research progress of family intervention in the prevention and treatment of delirium in ICU[J]. Chin J Emerg Crit Care Nurs, 2022, 3(2):173-176.