全面无反应性量表在有创机械通气患者意识状态评估中的应用  

Application of Full Outline of Un Responsiveness score in the assessment of conscious state for patients with invasive mechanical ventilation

作　　者：王莹[1] 马洁[1] 张磊[1] 宋文静[1] 常佳丽[1] 楚亚菲[1] 

机构地区：[1]天津市第一中心医院ICU,天津市300192

出　　处：《中华护理杂志》2014年第12期1462-1466,共5页Chinese Journal of Nursing

基　　金：国家临床重点专科建设项目

摘　　要：目的探讨全面无反应性(Full Outline of Un Responsiveness,FOUR)量表对有创机械通气患者意识障碍程度评估的适用性及准确性。方法选择我院有创机械通气伴意识障碍患者108例作为研究对象。在患者入ICU 24h内由1名工作5年以下的护士(A组)、1名工作5年以上的护士(B组)和患者主管医生(C组)分别采用格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)和FOUR量表对患者进行意识障碍程度的评估。主管医生记录患者急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)分值,并对入组患者进行脑电双频指数(bispectral index,BIS)监测。追踪入组患者28d临床结局。结果 3组评估者对同一患者评估得出的GCS总分、GCS中运动反应、睁眼反应得分及FOUR量表总分和FOUR量表各计分项目得分差异无统计学意义(P>0.05),而GCS的语言反应项目得分差异有统计学意义(P<0.05)。3组应用两种量表的评估总分与患者APACHEⅡ得分及BIS得分的相关性分析结果显示,量表总分与患者BIS得分均成正相关,与患者APACHEⅡ得分成负相关(P<0.01)。在对预测患者预后的辨别力分析上,3组应用FOUR量表预测28d存活均具有较好辨别力(曲线下面积>0.7)。结论采用FOUR量表对有创机械通气患者意识障碍程度进行评估具有准确性,且对患者的预后预测具有可靠性,因此,对有创机械通气患者的意识障碍程度判断FOUR量表评分较GCS评分具有优势。Objective To evaluate the feasibility and accuracy of Full Outline of UnResponsiveness （FOUR） score in the assessment of conscious state for patients with invasive mechanical ventilation. Methods A total of 108 patients with invasive mechanical ventilation and conscious disturbance were recruited in this study. The conscious state of each patient was assessed using Glasgow Coma Scale （GCS） and FOUR score by a nurse with less than 5 years of work experience（group A）,a nurse with more than 5 years of work experience（group B）,and the responsible physician（group C） independently. Moreover,the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score and bispectral index（BIS） was continuously monitored. The 28-day outcome of patients was recorded. Results There was significant difference in the GCS verbal response score rated by different medical staffs （P〈 0.05）,while no significant difference was found in the GCS total score,GCS motion response score,eyes open reaction score and FOUR score （P〉0.05 ）. The GCS score and FOUR score was positively correlated with BIS score, while negatively correlated with APPACHE Ⅱ score. In terms of predictive power for survival,FOUR score had good predictive power for 28-day survival （area under the curve〉0.7）. Conclusion The FOUR score can accurately assess the conscious state of patients with mechanical ventilation. It is reliable to predict the clinical outcomes.

关 键 词：意识障碍 格拉斯哥昏迷量表 呼吸 人工 脑电双频指数 

分 类 号：R472[医药卫生—护理学]