目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理...目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果 303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。展开更多
目的探讨肾移植术后监护期出现谵妄的临床分析及应对措施。方法方便选取该院2013年1月—2016年6月肾移植术后于监护期进行抗排斥治疗34例患者为研究对象,运用ICU患者意识模糊评估法(Confusion Assessment Method for Intensive Care Uni...目的探讨肾移植术后监护期出现谵妄的临床分析及应对措施。方法方便选取该院2013年1月—2016年6月肾移植术后于监护期进行抗排斥治疗34例患者为研究对象,运用ICU患者意识模糊评估法(Confusion Assessment Method for Intensive Care Unit,CAM-ICU CAM-ICU)对移植术后监护期抗排斥治疗的患者进行谵妄的评估,筛选出谵妄患者,并根据谵妄的临床症状和病因分析进行药物与非药物的应对措施。结果肾移植术后于监护期进行抗排斥治疗34例患者中有14.71%(5/34)出现谵妄,分析其原因,由疾病因素引起的有8.82%(3/34),由药物和环境因素引起各2.94%(1/34),疾病因素相比,差异无统计学意义(P>0.05);根据出现谵妄的原因给予疾病治疗、使用镇静药、停药或加药、半开放探视等应对措施均使谵妄好转。结论 CAM-ICU能有效的对谵妄进行评估,对肾移植术后监护期的患者给予护理干预措施,可以减少谵妄等并发症的发生,促进患者恢复健康。展开更多
目的比较ICU意识模糊量表评估法(the confusion assessment method for the intensive care unit,CAM-ICU)与临床直接观察法发现心脏术后ICU谵妄的一致性和先后情况,以探讨CAM-ICU量表在谵妄评估中的应用价值。方法便利抽样选择2016年1-...目的比较ICU意识模糊量表评估法(the confusion assessment method for the intensive care unit,CAM-ICU)与临床直接观察法发现心脏术后ICU谵妄的一致性和先后情况,以探讨CAM-ICU量表在谵妄评估中的应用价值。方法便利抽样选择2016年1-5月入住第二军医大学长海医院心血管外科ICU且入住时间>24h的心脏术后患者,同时采用CAMICU量表法和临床直接观察法进行谵妄判断,每班1次,记录结果并进行比较分析。结果全组281例心脏术后患者谵妄阳性率CAM-ICU评估为23.84%(67/281),临床直接观察法评估为21.35%(60/281),结果表明,两组间有较高的一致性(Kappa系数为0.86);谵妄阳性病例中,CAM-ICU量表法首次发现谵妄时间为术后63(31,128)h,临床直接观察法为术后44(26,79)h,临床观察法发现谵妄要晚于CAM-ICU量表法(P<0.001)。结论两种观察法均可用于ICU谵妄的评估,但临床直接观察法发现谵妄较晚,故建议采用CAM-ICU量表对患者进行谵妄评估,以及早发现及早处理。展开更多
[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital wer...[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.展开更多
文摘目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果 303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。
文摘目的探讨肾移植术后监护期出现谵妄的临床分析及应对措施。方法方便选取该院2013年1月—2016年6月肾移植术后于监护期进行抗排斥治疗34例患者为研究对象,运用ICU患者意识模糊评估法(Confusion Assessment Method for Intensive Care Unit,CAM-ICU CAM-ICU)对移植术后监护期抗排斥治疗的患者进行谵妄的评估,筛选出谵妄患者,并根据谵妄的临床症状和病因分析进行药物与非药物的应对措施。结果肾移植术后于监护期进行抗排斥治疗34例患者中有14.71%(5/34)出现谵妄,分析其原因,由疾病因素引起的有8.82%(3/34),由药物和环境因素引起各2.94%(1/34),疾病因素相比,差异无统计学意义(P>0.05);根据出现谵妄的原因给予疾病治疗、使用镇静药、停药或加药、半开放探视等应对措施均使谵妄好转。结论 CAM-ICU能有效的对谵妄进行评估,对肾移植术后监护期的患者给予护理干预措施,可以减少谵妄等并发症的发生,促进患者恢复健康。
文摘目的比较ICU意识模糊量表评估法(the confusion assessment method for the intensive care unit,CAM-ICU)与临床直接观察法发现心脏术后ICU谵妄的一致性和先后情况,以探讨CAM-ICU量表在谵妄评估中的应用价值。方法便利抽样选择2016年1-5月入住第二军医大学长海医院心血管外科ICU且入住时间>24h的心脏术后患者,同时采用CAMICU量表法和临床直接观察法进行谵妄判断,每班1次,记录结果并进行比较分析。结果全组281例心脏术后患者谵妄阳性率CAM-ICU评估为23.84%(67/281),临床直接观察法评估为21.35%(60/281),结果表明,两组间有较高的一致性(Kappa系数为0.86);谵妄阳性病例中,CAM-ICU量表法首次发现谵妄时间为术后63(31,128)h,临床直接观察法为术后44(26,79)h,临床观察法发现谵妄要晚于CAM-ICU量表法(P<0.001)。结论两种观察法均可用于ICU谵妄的评估,但临床直接观察法发现谵妄较晚,故建议采用CAM-ICU量表对患者进行谵妄评估,以及早发现及早处理。
基金Supported by Philosophy and Social Science Research Project of Hubei Education Department in 2022(22D092)Guiding Scientific Research Project of Shiyan Science and Technology Bureau in 2022(22Y34).
文摘[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.
