| 赵凤阳,黄叶莉,邱宝安.程序化综合护理对老年肝胆外科患者术后谵妄的预防作用研究[J].上海护理,2020,20(3): |
| 程序化综合护理对老年肝胆外科患者术后谵妄的预防作用研究 |
| Procedural comprehensive nursing in the prevention of postoperative delirium in older patients with open hepatobiliary surgery |
| DOI： |
| 中文关键词: 程序化综合护理 术后谵妄 CAM-ICU量表 CAM-S量表 |
| 英文关键词:procedural comprehensive nursing postoperative delirium CAM-ICU CAM-S |
| 基金项目:军队后勤科研应用基础研究重点项目(编号：BHJ13C001) |
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| 中文摘要: |
| 目的：探讨护理主导的程序化综合护理对老年肝胆外科患者术后谵妄的预防作用。方法：选择在我院肝胆外科接受开腹手术治疗,术后入加强医疗单元(ICU)治疗的老年患者(65-80岁)100例,随机等分入常规护理组(对照组)和程序化综合护理组(干预组)。采用CAM-ICU量表,观察两组患者术后1-7天的谵妄发生率；采用CAM-S量表,观察谵妄的严重程度。结果：程序化综合护理组患者术后7天内谵妄的发生率为22%,低于常规护理组的48%(χ2=7.429,P=0.006)。干预组CAM-S评分在术后第1-5天均低于常规护理组。结论：程序化综合康复护理可降低老年肝胆外科患者术后谵妄的发生率和谵妄严重程度。 |
| 英文摘要: |
| Objective: To investigate the effect of procedural comprehensive nursing in the prevention of postoperative delirium in older patients after open hepatobiliary surgery. Methods: One hundred older patients scheduled for open hepatobiliary surgery were randomly divided into intervention and control group (n=50 per group). Patients in the control group received standard nursing and those in the intervention group received further procedural comprehensive nursing targeting the risk factors for delirium during the perioperative period. The multidisciplinary intervention included nursing staff education, patients education, psychological and social support, sleep quality enhancement, and optimized pain management. The incidence of postoperative delirium measured using CAM-ICU and the severity of postoperative delirium measured using CAM-S were compared between groups. We further compared the differences in the duration of delirium, the time of ICU stay and hospital stay. Results: Patients in the two groups were similar in baseline and intraoperative characteristics. Procedural comprehensive nursing was associated with reduced incidences of delirium during the first 7 days after surgery compared with standard nursing (χ2=7.429,P=0.006). Furthermore, the severity of delirium was less in patients accepting procedural comprehensive nursing compared with those with standard nursing on postoperative day 1 (P=0.019), 2 (P=0.022), 3 (P=0.032), 4 (P=0.020) and 5 (P=0.033). Compared with control, the intervention group showed shorter duration of delirium and ICU stay (P=0.004 and 0.043 respectively) and no significant changes of time of hospital stay (P=0.681). Conclusion: Procedural comprehensive nursing can reduce the incidence, severity and duration of postoperative delirium as well as shorten ICU stay. |
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