老年危重患者早期活动预防谵妄的最佳证据总结  

Early mobilisation in prevention of delirium in critically ill aged patients:a summary of the best available evidence

作　　者：姜云龙 黄昉芳[1] 卫建华[2] 翁峰霞[2] 桑明 Jiang Yunlong;Huang Fangfang;Wei Jianhua;Weng Fengxia;Sang Ming(Department of Intensive Care Unit,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310006,China;Surgical Intensive Care Unit,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310006,China)

机构地区：[1]浙江大学医学院附属第一医院综合监护室,浙江杭州310006 [2]浙江大学医学院附属第一医院外科重症监护室,浙江杭州310006

出　　处：《现代临床护理》2023年第8期76-82,共7页Modern Clinical Nursing

基　　金：浙江省医药卫生科技计划项目,项目编号为2022594989;浙大一院护理科研项目,项目编号为2022ZYHL018。

摘　　要：目的总结早期活动在预防老年危重患者谵妄发生的相关证据,为临床医护人员实施早期活动方案提供参考。方法系统检索国内外中英文数据库及指南网与在早期活动预防老年危重患者谵妄发生的相关证据,检索时限为2010年1月至2022年3月。由2名研究者分别进行文献质量评价、证据提取和证据总结。结果共纳入9篇相关文献,包括系统评价3篇、指南2篇及专家共识,循证实践、原始研究、类试验研究各1篇。通过对证据的汇总,最终分别从组建早期活动协作团队、早期活动与谵妄预防知识宣教、谵妄评估、早期活动评估、早期活动开始时间、早期活动内容与方式、早期活动终止标准、早期活动应急预案7个方面形成了33条最佳证据。结论该研究总结了早期活动对预防老年危重患者谵妄发生的最佳证据,医护人员应结合患者实际情况及需求,针对性地选择证据并制订与实施科学和有效的早期活动方案,以减少老年危重患者谵妄的发生。Objective To summarise the relevant evidences on the application of early mobilisation in prevention of delirium in critically ill aged patients and provide references for implementation of early mobilisation programs by clinical healthcare professionals.Methods From January 2010 to March 2022,a systematic literature search on both domestic and international databases and guideline websites in Chinese and English was conducted to collect relevant literatures on early mobilisation for prevention of delirium in critically ill aged patients.Two researchers independently assessed the quality of the literatures,extracted the evidences,and summarised the findings.Results A total of 9 relevant studies were included,including three systematic reviews,two guidelines and expert consensus and one literature per topic in review on expert consensus,systematic review,evidence-based practice,original research and quasiexperimental study.Through evidence synthesis,a total of 33 pieces of best available evidence were identified in 7 aspects including the establishment of early mobilisation collaboration team,delirium education with early mobilisation,delirium assessment,early mobilisation assessment,time for early initiation of mobilisation,content of early mobilisation,criteria for termination of early mobilisation and contingency plan for early mobilisation.Conclusions This study summarises the best available evidences in the application of early mobilisation in prevention of delirium in critically ill elderly patients.Healthcare professionals should carry out targeted selection and implementation of evidence-based effective early mobilisation programs on the basis of actual conditions and needs of the patients,in order to reduce the incidence of delirium in critically ill elderly patients.

关 键 词：早期活动 谵妄 老年危重患者 证据总结 

分 类 号：R459.7[医药卫生—急诊医学]