冠状动脉搭桥术后谵妄患者的循证治疗  

Evidence-based treatment for delirium patients after coronary artery bypass grafting

作　　者：左红霞[1] 张超[1] 彭乐[1] 王梦荷[2] 牛玉明[1] ZUO Hong-xia;ZHANG Chao;PENG Le;WANG Meng-he;NIU Yu-ming(Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan 442000, China)

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)循证医学中心,十堰442000 [2]十堰市太和医院(湖北医药学院附属医院)护理部,十堰442000

出　　处：《中国循证心血管医学杂志》2017年第4期388-391,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：湖北省自然科学基金项目(2016CFB567);湖北省卫生计生科研基金资助项目(WJ2017F069)

摘　　要：目的为非体外循环下冠状动脉搭桥术后谵妄患者制定合理的循证治疗方案。方法在充分评估患者病情基础上,提出临床问题并转换成便于检索的形式,检索Cochrane Library,Pub Med,EMbase,CBM,CNKI,VIP和Wan Fang数据库。结果共检索出有关术后谵妄评估工具、谵妄风险(麻醉方式、高血压、糖尿病、心律失常)、镇静药物的使用相关的Meta分析4篇,系统评价(systematic review,SR)1篇,随机对照试验(randomized controlled trials,RCT)2篇,综述1篇。根据检索结果,并结合患者病情和意愿,制定出有效的谵妄治疗方案:采用重症监护室意识模糊评估法(confusion assessment method for the intensive care unit,CAM-ICU)工具对患者进行动态、客观的评估,采用纳洛酮联合奥氮平药物治疗,积极治疗和控制高血压、糖尿病、心律失常的原发病变。结论采用循证证据评价为冠状动脉搭桥术后谵妄患者制定全面的治疗方案来促进谵妄的治疗及愈合。Objective To formulate an evidence-based treatment plan for the patients with delirium after off-pump coronary artery bypass surgery.Methods Based on an adequate review of patients’conditions,the databases of Cochrane Library,PubMed,EMbase,CBM,CNKI,VIP Database and WanFang Database were retrieved after translating clinical problems to available to retrieving.Results There were totally4postoperative Meta-analyses on delirium assessment tools,risk factors(anesthesia ways,hypertension,diabetes,and arrhythmia)and administration of sedative drugs,1systematic review(SR),2randomized controlled trials(RCT)and1review were collected.According to retrieving results and patients’conditions and preference,an effective treatmentplan was formulated as follows:the patients were dynamically and objectively reviewed by using confusion assessment method for the intensive care unit(CAM-ICU),treated with naloxone combining olanzapine,and original diseases were actively treated and controlled including hypertension,diabetes and arrhythmia.Conclusion The comprehensive treatment plan is formulated by applying evidence-base review for promoting the curative effect and cure in patients with delirium after off-pump coronary artery bypass surgery.

关 键 词：心脏术后 谵妄 谵妄评估工具 镇定药 循证治疗 

分 类 号：R654.2[医药卫生—外科学]