常规护理联合早期活动对预防ICU机械通气患者谵妄的应用研究

目的 探讨常规护理联合早期活动对预防重症监护病房(intensive care unit,ICU)机械通气患者谵妄的影响。 方法 收集温州医科大学附属第五医院(丽水市中心医院)重症医学科2014年7月—2016年6月接受机械通气的患者180例,根据随机数字法分为干预组和对照组,对照组给予常规护理,干预组在常规护理的基础上进行早期活动。收集2组患者的临床资料。 结果 干预组和对照组入ICU<8 h谵妄的发生率比较差异无统计学意义(P>0.05),干预组入ICU 8~48 h、48 h~出ICU谵妄的发生率(8.9%、2.2%)均低于对照组(25.6%、14.4%)(P<0.05),干预组ICU总谵妄率(20.0%)低于对照组(50.0%)(P<0.05);干预组谵妄活动减少型、活动增多型、混合型比例和对照组比较差异无统计学意义(P>0.05),63例谵妄患者中活动减少型4例,活动增多型37例,混合型22例;干预组谵妄发生时间[(2.32±1.46) d]和对照组[(2.41±1.54) d]比较差异无统计学意义(P>0.05),干预组谵妄持续时间[(1.87±1.25) d]短于对照组[(3.06±1.69) d](P<0.05);干预组患者的通气时间、治疗费用、ICU住院时间[(91.23±43.26) h、(1.58±0.87)万元、(6.32±4.31) d]均低于对照组[(122.25±51.27) h、(2.12±1.24)万元、(8.67±4.65) d](P<0.05)。 结论 常规护理联合早期活动能够降低ICU机械通气患者谵妄的发生率,缩短谵妄持续时间和ICU住院时间,降低治疗费用,对谵妄的分型和通气时间无明显影响。 

Application effect of routine nursing combined with early activities to prevent the delirium in patients with mechanical ventilation in ICU

Objective To explore the effect of routine nursing combined with early activities in the prevention of delirium in patients with mechanical ventilation in intensive care unit (ICU). Methods We collected 180 patients receiving mechanical ventilation in ICU from July 2014 to June 2016 in the Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital). The patients were randomly divided into intervention group and control group. The control group was given conventional care, and the intervention group was given early movement on the basis of routine care. The clinical data of the two groups were collected. Results There was no significant difference in the incidence of delirium into the ICU < 8 h between the intervention group and the control group (P > 0. 05). The incidence of delirium into the ICU 8-48 h, 48 h-out ICU of the intervention group (8. 9%, 2. 2%) were lower than those in the control group (25. 6%, 14. 4%), P < 0. 05. The total delirium rate of the intervention group (20. 0%) was lower than that in the control group (50. 0%), P < 0. 05. There was no significant difference in the proportion of delirium reduced activity type, increased activity type and mixed type between the intervention group and the control group (P > 0. 05). In 63 patients with delirium, there were 4 cases of reduced activity, 37 cases of increased activity, and 22 cases of mixed type. There was no significant difference in the delirium occurring time between the intervention group[(2. 32 ±1. 46) days] and the control group[(2. 41 ±1. 54) days], P > 0. 05. The duration of delirium in the intervention group[(1. 87 ±1. 25) days]was shorter than that in the control group[(3. 06 ±1. 69) days], P < 0. 05. The duration of ventilation, treatment cost, hospital stay[(91. 23 ±43. 26) h, (1. 58 ±0. 87) ten thousand yuan, (6. 32 ±4. 31) days]in the intervention group were lower than those in the control group[(122. 25 ±51. 27) h, (2. 12 ±1. 24) ten thousand yuan, (8. 67 ±4. 65) days], P < 0. 05. Conclusion The combination of routine care and early intervention can reduce the incidence of delirium in patients with ICU mechanical ventilation, reduce delirium duration and ICU stay, reduce treatment costs, and have no significant effect on delirium classification and ventilation time.