ICU意识模糊量表与临床直接观察在心脏术后谵妄评估中的差异性研究  

The difference of the delirium evaluation between ICU fuzzy scale and clinical direct observation after cardiac surgery

作　　者：张伟英[1] 梁珠阳 陶丽[1] 

机构地区：[1]第二军医大学第一附属医院心血管外科,上海长海医院,上海200433

出　　处：《护士进修杂志》2017年第13期1161-1164,共4页Journal of Nurses Training

基　　金：上海市卫生和计划生育委员会科研课题(编号:201440100)

摘　　要：目的比较ICU意识模糊量表评估法(CAM-ICU)与临床直接观察法在心脏术后谵妄评估中的差异性,探讨CAM-ICU量表在谵妄评估中的临床意义。方法对心脏外科术后ICU监护期间的患者进行谵妄评估,每班1次,先后由责任护士和研究小组分别用临床直接观察法和CAM-ICU量表判断患者是否发生谵妄,记录结果并进行差异性分析。结果全组281例,CAM-ICU谵妄发生率23.84%(67/281)。共进行有效评估2 304组,其中临床直接观察法判断谵妄阳性的有228次,ICU-CAM判断阳性的263次,两种评估结果不一致的有55组。按CAM-ICU量表为谵妄诊断标准,55组中误诊10次,漏诊45次。结论临床直接观察法对谵妄评估可能存在漏诊或误诊,建议采用CAM-ICU量表对患者进行谵妄评估,及早、正确评估发现谵妄。Objective To study the difference between the confusion assessment method for the intensive care unit（CAM-ICU） and clinical direct observation in delirium assessment for patients underwent heart surgery,and to discuss the clinical significance of CAM-ICU. Methods Delirium was screened once a shift for patients during their postoperative ICU period after heart surgery,using clinical direct observation by patients’ registered nurses and CAM-ICU scale by research team one after another. Results 281 cases were studied. The incidence of delirium was 23. 80%（ 67/281） according to CAM-ICU criteria. 2304 pairs of assessment were effective,including 228 delirium positive by clinical direct observation,263 positive by ICU-CAM,and 55 pairs of assessment presented delirium development by two kinds of methods inconsistently. Of 55 pairs,10 was misdiagnosis and 45 missed diagnosis according to CAM-ICU criteria. Conclusions Delirium may be misdiagnosed or miss diagnosed by clinical direct observation. This finding suggests that delirium should be assessed by CAM-ICU,diagnosing delirium correctly at an early date.

关 键 词：谵妄 评估 临床直接观察 ICU意识模糊量表 

分 类 号：R473[医药卫生—护理学] R654.2[医药卫生—临床医学]