中文版4项谵妄快速诊断方案和护理谵妄筛查量表用于老年痴呆并发脑梗死患者谵妄评估的效果比较  

Comparison of efficacy of Chinese version 4AT and Nursing Delirium Screening Scale in assessing delirium in senile dementia patients complicated with cerebral infarction

作　　者：刘玲利 王丽 燕小丽 张维 Liu Lingli;Wang Li;Yan Xiaoli;Zhang Wei(Department of Neurology,Huaibei Miners General Hospital,Huaibei,Anhui,235000,P.R.China)

机构地区：[1]淮北矿工总医院神经内科,安徽淮北235000

出　　处：《老年医学与保健》2025年第1期83-87,共5页Geriatrics & Health Care

摘　　要：目的比较中文版4项谵妄快速诊断方案(the 4 A's Test,4AT)与护理谵妄筛查量表(Nursing Delirium Screening Scale,Nu DESC)评估老年痴呆并发脑梗死患者谵妄的效果差异。方法选取2022年6月—2024年6月入住淮北矿工总医院神经内科既往诊断为老年痴呆的患者,本次因脑梗死发病入院治疗的118例患者作为研究对象,入院后采用自制一般资料调查表收集相关资料,完成中文版4AT及Nu-DESC调查,以美国精神疾病与统计手册(第四版)(DSM-Ⅳ)谵妄评估表作为谵妄评估诊断金标准,对比2种评估工具评估谵妄的效能,具体评价指标包括受试者工作特征曲线(ROC)、曲线下面积(AUC)分析、Kappa值以及Bayes判别法。结果以DSM-Ⅳ谵妄评估表作为金标准,结果显示中文版4AT和Nu-DESC与金标准的一致性检验kappa值分别为0.84和0.75,诊断一致性均较良好,但总体而言中文版4AT的评估结果与DSM-Ⅳ谵妄评估表评估结果更为相近;中文版4AT和Nu-DESC的ROC曲线下面积分别为0.91和0.86,两者AUC差值为0.05(Z=3.22,P<0.01),灵敏度分别为0.84和0.89,特异度分别为0.92和0.81,总体而言中文版4AT的诊断能力更佳;以DSM-Ⅳ为谵妄诊断金标准并设为因变量,以中文版4AT评分和Nu-DESC评分设为自变量进行Bayes判别分析,结果显示中文版4AT交叉验证准确率为88.6%,高于Nu-DESC的82.7%。结论相比于Nu-DESC量表,中文版4AT量表用于老年痴呆合并脑梗死患者的谵妄评估效果更佳。Objective To compare the efficacy of the Chinese version of the 4 A's Test(4AT)and the Nursing Delirium Screening Scale(Nu-DESC)in assessing delirium in senile dementia patients complicated with cerebral infarction.Methods 118 patients who were previously diagnosed with senile dementia and admitted for treatment due to cerebral infarction in Department of Neurology of Huaibei Miners General Hospital from June 2022 to June 2024 were selected as research subjects.After admission,a self-designed general information questionnaire was used to collect their relevant data.The degree of delirium was assessed by Chinese version 4AT and Nu-DESC,respectively.The delirium assessment form of the American Diagnostic and Statistical Manual of Mental Disorders(Fourth Edition)(DSM-IV)was used as the gold standard for the assessment and diagnosis of delirium.The diagnostic performance of the two assessment tools in evaluating delirium was compared.The specific evaluation indexes included receiver operating characteristic curve(ROC),area under curve(AUC)analysis,Kappa value and Bayes discrimination method.Results Taking the DSM-IV delirium assessment form as the gold standard,the results showed that the Kappa value of the Chinese version 4AT and Nu DESC was 0.84 and 0.75,respectively,indicating good diagnostic consistency with the gold standard.But overall,the evaluation results of the Chinese version 4AT were more similar to those of the DSM-IV delirium assessment form.The areas under the ROC curve(AUC)of the Chinese version 4AT and Nu DESC were 0.91 and 0.86,respectively.The AUC difference between the two methods was 0.05(Z=3.22,P<0.01).Their sensitivity was 0.84 and 0.89,and the specificity was 0.92 and 0.81,respectively.In general,the diagnostic performance of the Chinese version 4AT was better.The DSM-Ⅳwas used as the gold standard for delirium diagnosis and was set as the dependent variable.The Chinese version 4AT score and Nu-DESC score were set as the independent variables for Bayes discriminant analysis.The results showe

关 键 词：老年 痴呆 脑梗死 谵妄 中文版4AT 护士用谵妄筛查量表 

分 类 号：R47[医药卫生—护理学]