两种观察法对ICU谵妄评估的效果研究  

Study of the Effects of Two Observation Methods in the Assessment of ICU Delirium

作　　者：梁珠阳 苏传芹[1] 陶丽[1] 邱文娟[1] 张伟英[2] 

机构地区：[1]第二军医大学长海医院心血管外科,上海200433 [2]第二军医大学长海医院护理部

出　　处：《解放军护理杂志》2017年第9期44-46,62,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：上海市卫生和计划生育委员会科研课题(201440100)

摘　　要：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。Objective To study and compare the difference and sequence in assessment of ICU delirium with the confusion assessment methods for the intensive care unit（CAM-ICU） and direct clinical observation methods after heart surgery.Methods By convenience sampling,patients stayed in ICU longer than 24h after heart surgery were selected and using clinical direct observation by patients＇ registered nurses and the CAM-ICU by research team successively, delirium was assessed once a shift.The incidence of delirium and kappa coefficient of two methods were compared. Results Totally 281 patients were included in the study.The incidence of delirium was 23.84%（67/281） according to CAM-ICU criteria and 21.35%（60/ 281） by clinical direct observation.The two methods had high consistency（kappa coefficients 0.86）.Of the cases presenting delirium, the first detection of delirium was 63 （31,128） hours after surgery by CAMICU,44（26,79） hours by clinical direct observation.The first detection of delirium by clinical direct observation was significantly later than that of CAM-ICU（P^0.001）.Conclasions Two methods can both be used for the assessment of ICU delirium.Delirium may be diagnosed later by clinical direct observation.This finding suggests that delirium should be assessed by CAM-ICU,diagnosing delirium earlier.

关 键 词：谵妄 评估 临床直接观察法 ICU意识模糊量表评估法 

分 类 号：R197.323[医药卫生—卫生事业管理]