重症监护室成年病人谵妄非药物干预最佳证据的应用研究  

Application of the best evidence for non-pharmacological intervention of delirium in adult patients in the intensive care unit

作　　者：张伟[1] 汤云[1] 江海娇[2] 袁莉萍[3] 张卫 于涛[1] 柳军 ZHANG Wei;TANG Yun;JIANG Hai-jiao;YUAN Li-ping;ZHANG Wei;YU Tao;LIU Jun(Neurosurgery Intensive Care Unit,The First Affiliated Hospital of Wannan Medical College,Wuhu Anhui 241001,China;Intensive Care Unit,The First Affiliated Hospital of Wannan Medical College,Wuhu Anhui 241001,China;Department of Nursing,The First Affiliated Hospital of Wannan Medical College,Wuhu Anhui 241001,China;Department of Rehabilitation Medicine,The First Affiliated Hospital of Wannan Medical College,Wuhu Anhui 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经外科ICU,安徽芜湖241001 [2]皖南医学院弋矶山医院ICU,安徽芜湖241001 [3]皖南医学院弋矶山医院护理部,安徽芜湖241001 [4]皖南医学院弋矶山医院康复医学科,安徽芜湖241001

出　　处：《蚌埠医学院学报》2023年第12期1759-1765,共7页Journal of Bengbu Medical College

基　　金：安徽省重点研究与开发计划项目(201904a07020034);皖南医学院中青年项目(WKS2021F03)。

摘　　要：目的总结ICU成年病人谵妄非药物干预的最佳证据,并评价其应用效果。方法按照“6S”证据金字塔模型系统检索文献,获取并总结ICU成年病人谵妄非药物干预的最佳证据。采用方便抽样法选取安徽省芜湖市某三甲医院ICU护理人员40名以及ICU病人150例。基于Joanna Briggs Institute(JBI)循证卫生保健模式为理论框架,通过现状审查、分析证据应用的障碍因素、证据引入以及对证据应用后再次审查,比较最佳证据应用前后病人谵妄的发生率及病人的临床转归情况、护理人员对谵妄预防及管理知识水平情况。结果最终纳入17条最佳证据,包括危险因素辨识和风险预测、评估与诊断、身体约束、认知训练、家属参与、睡眠管理、早期康复锻炼7个部分。最佳证据应用后,ICU病人谵妄发生率及非计划性拔管发生率显著降低,住院时间显著缩短(P<0.05),谵妄持续时间缩短(P<0.01);护理人员的相关知识水平均有所提高(P<0.05);证据应用后再次审查时,各项审查标准的执行率均高于现状审查。结论ICU成年病人谵妄非药物干预最佳证据的应用改善了谵妄管理流程,可以预防和降低ICU病人谵妄发生率,改善病人转归。Objective To summarize the best evidence for non-pharmacological intervention of delirium in adult patients in ICU,and evaluate the effect of its application.Methods According to the"6S"evidence pyramid model system,the literature was searched to obtain and summarize the best evidence of non-pharmacological interventions for delirium in adult ICU patients.There were 40 ICU nurses and 150 patients were recruited in a tertiary hospital in Wuhu,Anhui province by using the convenience sampling method.Based on the Joanna Briggs Institute(JBI)evidence-based health care model as the theoretical framework,through baseline audit,analysis of obstacles to the application of evidence,introduction of evidence,as well as re-audit of evidence after application,compare the incidence of delirium,the clinical outcome of patients and the level of knowledge of nurses on the prevention and management of delirium before and after the application of the best evidence.Results Finally,17 best evidences were included,including seven parts:risk factor identification and risk prediction,assessment and diagnosis,physical restraint,cognitive training,family participation,sleep management and early rehabilitation exercise.After the application of the best evidence,the incidence of delirium and unplanned extubation in ICU patients were significantly reduced,the length of hospitalization was significantly shortened(P<0.05),and the duration of delirium was shortened(P<0.01).The level of relevant knowledge of nursing staff was improved(P<0.05).When the evidence was reviewed again after application,the implementation rate of each review standard was higher than the current review.Conclusions The application of the best evidence for non-pharmacological intervention of delirium in adult patients in ICU has improved the delirium management process,which can prevent and reduce the incidence of delirium in patients,and improved clinical outcomes of patients.

关 键 词：谵妄 非药物干预 重症监护室 循证实践 

分 类 号：R74[医药卫生—神经病学与精神病学]