基于循证的ICU危重患者谵妄预防及管理最佳证据总结  

Summary of the Best Evidence for the Prevention and Management of Delirium of critically ill patients in ICU

作　　者：张伟[1] 江海娇[1] 袁莉萍[2] 李坤坤 鲁卫华[1] 吴允东[1] 曹迎亚[1] 柳军 ZHANG Wei(Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China)

机构地区：[1]皖南医学院弋矶山医院重症医学科,安徽芜湖241000 [2]皖南医学院弋矶山医院护理部,安徽芜湖241000 [3]皖南医学院弋矶山医院康复医学科,安徽芜湖241000

出　　处：《牡丹江医学院学报》2021年第6期34-39,33,共7页Journal of Mudanjiang Medical University

基　　金：国家自然科学基金青年项目(82002092);安徽省中央引导地方科技发展项目(1604f0804043)。

摘　　要：目的总结ICU危重患者谵妄预防及管理的最佳证据。方法按照“6S”证据金字塔模型检索JBI循证卫生保健数据库、Cochrane图书馆、PuMed、Embase、中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、英国国家卫生和临床优化研究所(NICE)等数据库中有关ICU危重患者谵妄预防及管理的指南、系统评价、证据总结、专家共识以及随机对照研究,并由两名评价员独立评价文献质量并评定证据等级及推荐级别。结果本研究共纳入15篇文献,其中包括5篇指南,2篇系统评价,8篇随机对照研究,确定了谵妄评估、镇静镇痛策略、身体约束、非药物干预以及早期康复锻炼5个部分,共20项最佳证据,其中11项证据为A级推荐、9项为B级推荐。结论护理人员应根据ICU危重患者谵妄预防及管理的最佳循证证据,改善谵妄的管理流程,加强对危重患者谵妄的早期预防,以降低ICU患者谵妄发生率,改善患者转归。To summarize the best evidence for the prevention and management of delirium of critically ill patients in ICU.Methods According to the"6S"evidence pyramid model,JBI Evidence-based Health Care Database,Cochrane Library,PuMed,Embase,CNKI,Wanfang database,CBM,NICE,BMJ Best Practice,SCCM,ACCM were searched to obtain the guidelines,systematic reviews,evidence summary,expert consensus,and randomized controlled studies on the prevention and management of delirium of critically ill patients in ICU,and two reviewers evaluated the quality of the literature and assessed the level of evidence and recommendation independently.Results 5 studies were adopted,including 5 guidelines,2 systematic reviews,and 8 randomized controlled studies,which identified 5 parts,which included delirium assessment,sedation and analgesia strategies,physical restraint,non-pharmacological intervention and early rehabilitation exercise,and 20 best evidences,among which 11 items were grade A recommendation and 9 items were grade B recommendation.Conclusion The nurse should improve the management process of delirium based on the best evidence for the prevention and management of delirium in critically ill patients in ICU,and strengthen the early prevention of delirium in critically ill patients,so as to reduce the incidence of delirium in ICU patients and improve patient outcomes.

关 键 词：重症监护室 危重患者 谵妄 预防 循证护理 

分 类 号：R47[医药卫生—护理学]