舒适化浅镇静策略理念对冠心病重症监护病房患者谵妄的预防效果  

Preventive effect of early comfort using analgesia,minimal sedatives and maximal humane care concept on delirium in patients in coronary care unit

作　　者：柳娜 贺泽霞 刘曼 李婷婷 杨莎莎 徐英 LIU Na;HE Zexia;LIU Man;LI Tingting;YANG Shasha;XU Ying(Department of Cardiology,West China Hospital of Sichuan University,West China Nursing College of Sichuan University,Chengdu,Sichuan,610041)

机构地区：[1]四川大学华西医院心脏内科/四川大学华西护理学院,四川成都610041

出　　处：《实用临床医药杂志》2024年第2期101-104,108,共5页Journal of Clinical Medicine in Practice

基　　金：四川省自然科学基金项目(2022NSFSC1487)。

摘　　要：目的观察舒适化浅镇静策略(eCASH)理念对冠心病重症监护病房(CCU)患者谵妄的预防效果。方法回顾性分析2021年6月—2023年1月收治的136例CCU患者的临床资料。将2021年6月—2022年3月采用常规防范谵妄护理的患者纳入对照组(n=69),将2022年4月—2023年1月采用eCASH理念护理的患者纳入观察组(n=67)。比较2组患者谵妄预防效果、躁动镇静情况、CCU住院时间以及认知功能。结果观察组谵妄发生率为4.48%,低于对照组的17.39%,差异有统计学意义(P<0.05)。观察组谵妄持续时间、CCU住院时间短于对照组,差异有统计学意义(P<0.05)。干预后,2组Richmond躁动与镇静量表(RASS)评分、蒙特利尔认知评估量表(MoCA)各项指标评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组镇痛镇静药物(瑞捷、丙泊酚)平均使用剂量少于对照组,差异有统计学意义(P<0.05)。结论基于eCASH理念的镇痛镇静调控方案可降低CCU患者谵妄发生率,缩短谵妄持续时间和住院时间,改善其躁动镇静情况及认知功能。Objective To observe the preventive effect of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)concept on delirium in patients in coronary care unit(CCU).Methods The clinical data of 136 CCU patients admitted from June 2021 to January 2023 were retrospectively analyzed.Patients received routine delirium prevention care from June 2021 to March 2022 were included in control group(n=69),and patients received eCASH philosophy care from April 2022 to January 2023 were included in observation group(n=67).Delirium prevention effect,condition of restlessness and sedation,CCU length of stay and cognitive function were compared between the two groups.Results The incidence of delirium in the observation group was 4.48%,which was significantly lower than 17.39%in the control group(P<0.05).The duration of delirium and CCU length of stay in the observation group were significantly shorter than those in the control group(P<0.05).After intervention,the scores of Richmond Agitation and Sedation Scale(RASS)and Montreal Cognitive Assessment Scale(MoCA)were significantly higher in the two groups than before intervention,and the observation group was significantly higher than the control group(P<0.05).The average dose of analgesic and sedative drugs(propofol and regal)in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The analgesic and sedative control scheme based on eCASH concept can reduce the incidence of delirium,shorten the duration of delirium and hospital stay,and improve the agitation sedation and cognitive function of CCU patients.

关 键 词：冠心病 重症监护病房 舒适化浅镇痛策略 谵妄 镇静 镇痛 

分 类 号：R473[医药卫生—护理学] R614.3[医药卫生—临床医学] R745.1