ABCDEF集束化护理策略对心脏外科术后谵妄发生率和持续时间的影响

陈瑜; 邢红叶; 许兆军; 周小洋

doi:10.16766/j.cnki.issn.1674-4152.002965

ABCDEF集束化护理策略对心脏外科术后谵妄发生率和持续时间的影响

doi: 10.16766/j.cnki.issn.1674-4152.002965

宁波市第二医院重症医学科，浙江宁波 315000

基金项目:

浙江省基础公益研究计划项目 LY19H190001

浙江省医药卫生科技计划项目 2019KY184

详细信息

通讯作者:
陈瑜，E-mail: chenyuicu@163.com

中图分类号: R473.6 R654.2
计量
- 文章访问数: 177
- HTML全文浏览量: 93
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-22
- 网络出版日期: 2023-05-31

The effect of ABCDEF cluster nursing strategy on the incidence and duration of delirium after cardiac surgery

Department of Intensive Care Unit, Ningbo Second Hospital, Ningbo, Zhejiang 315000, China

摘要

摘要: 目的分析ABCDEF集束化护理策略在心脏外科术后患者中的应用及对患者术后谵妄发生情况的影响。方法选取2020年6月—2022年6月宁波市第二医院重症医学科收治的120例心脏外科术后患者作为研究对象，根据随机数字表法将其分为对照组和观察组各60例。对照组患者应用常规护理，观察组在对照组基础上应用ABCDEF集束化护理策略。比较2组患者术后谵妄风险评分及发生情况、护理前后睡眠质量及疼痛程度、机械通气时间、ICU停留时间及住院时间。结果入院时及术前1 d，2组患者谵妄风险评分比较差异无统计学意义(P>0.05)；随着时间的延长，2组谵妄风险评分比较差异有统计学意义(F_组间=10.233，P_组间 < 0.001)；观察组患者谵妄发生率为10.0%(6/60)，低于对照组的30.0%(18/60)，且观察组患者谵妄持续时间短于对照组(P < 0.05)。护理后，观察组睡眠质量及疼痛程度评分分别为8(3，12)分、(1.95±1.21)分，均低于对照组的12(7，16)分、(2.56±1.21)分，均P < 0.05；且观察组患者机械通气时间、ICU停留时间及住院时间均少于对照组(均P < 0.05)。结论 ABCDEF集束化护理策略可降低心脏外科术后患者谵妄发生率及谵妄持续时间，减轻患者术后疼痛，并能提高睡眠质量，减少患者住院时间。
- ABCDEF集束化护理策略 /
- 心脏外科 /
- 谵妄 /
- 疼痛 /
- 睡眠质量
Abstract: Objective To analyze the application of ABCDEF cluster nursing strategy in patients after cardiac surgery and its impact on postoperative delirium. Methods A total of 120 patients after cardiac surgery admitted to the Department of Critical Care of Ningbo Second Hospital from June 2020 to June 2022 were selected as the study subjects. They were divided into control group and observation group of 60 cases each according to the random number table method. The patients in the control group were treated with routine nursing, while the patients in the observation group were treated with ABCDEF cluster nursing strategy on the basis of the control group. The risk score and occurrence of postoperative delirium, sleep quality and pain severity before and after nursing were compared between the two groups, as well as the duration of mechanical ventilation, ICU stay and hospital stay. Results There was no significant difference in delirium risk score between the two groups at admission and 1 day before operation (P>0.05); With the extension of time, the difference of delirium risk score between the two groups was statistically significant (F_{between groups}=10.233, P_{between groups} < 0.001); The incidence of delirium in the observation group was 10.0% (6/60), lower than 30.0% (18/60) in the control group, and the duration of delirium in the observation group was shorter than that in the control group (P < 0.05). After nursing, the scores of sleep quality and pain degree in the observation group were 8 (3, 12) points and (1.95±1.21) points respectively, which were lower than those in the control group [12 (7, 16) points and (2.56±1.21) points, all P < 0.05]; The mechanical ventilation time, ICU stay and hospital stay of patients in the observation group were less than those in the control group (all P < 0.05). Conclusion The ABCDEF cluster nursing strategy can reduce the incidence and duration of delirium in patients after cardiac surgery, reduce postoperative pain, improve sleep quality and reduce hospital stay.
- ABCDEF cluster nursing scheme /
- Cardiac surgery /
- Delirium /
- Pain /
- Sleep quality

HTML全文

表 1 2组心脏外科术后患者一般资料比较

Table 1. Comparison of general data of patients after cardiac surgery between 2 groups

组别	例数	性别(例)		年龄(x±s，岁)	心功能分级(例)		手术类型(例)			手术时长 (x±s，h)	体外循环时长 (x±s，h)
组别	例数	男性	女性	年龄(x±s，岁)	2级	3级	冠脉搭桥术	瓣膜置换术	大血管手术	手术时长 (x±s，h)	体外循环时长 (x±s，h)
对照组	60	39	21	58.06±12.10	28	32	4	21	35	3.81±1.22	1.32±0.19
观察组	60	41	19	56.51±14.58	30	30	3	20	37	3.83±1.16	1.33±0.21
统计量		0.150^a		0.634^b	0.133^a		0.223^a			0.092^b	0.274^b
P值		0.699		0.528	0.716		0.895			0.927	0.785
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组心脏外科术后患者谵妄风险评分比较(x±s，分)

Table 2. Comparison of delirium risk scores of patients after cardiac surgery between 2 groups(x±s, points)

组别	例数	入院时	术前1 d	术后第1天	术后第2天	术后第3天
对照组	60	12.33±2.41	9.82±2.43	11.43±2.53	13.10±1.96	14.10±1.96
观察组	60	12.30±2.34	9.70±1.92	10.15±2.04	10.22±2.10	13.15±2.04
t值		0.069	0.300	3.051	7.766	2.601
P值		0.945	0.765	0.003	< 0.001	0.010

下载: 导出CSV

表 3 2组心脏外科术后患者谵妄发生率及持续时间比较

Table 3. Comparison of the incidence and duration of deliriumafter cardiac surgery between the two groups

组别	例数	谵妄发生情况[例(%)]				谵妄持续时间 (x±s，d)
组别	例数	躁动型	安静型	混合型	总发生	谵妄持续时间 (x±s，d)
对照组	60	11(18.3)	3(5.0)	4(6.7)	18(30.0)	2.4(1.5, 3.8)
观察组	60	4(6.7)	1(1.7)	1(1.7)	6(10.0)	0.9(0.5, 1.8)
统计量					7.500^a	16.898^b
P值					0.006	< 0.001
注：^a为χ²值，^b为Z值。

下载: 导出CSV

表 4 2组心脏外科术后患者护理干预前后睡眠质量及疼痛程度比较(分)

Table 4. Comparison of sleep quality and pain degree aftercardiac surgery between the two groups before and afternursing intervention(points)

组别	例数	睡眠质量[M(P₂₅, P₇₅)]		疼痛程度(x±s)
组别	例数	护理前	护理后	护理前	护理后
对照组	60	15(5，16)	12(7，16)	5(4, 6)	3(2, 4)
观察组	60	16(6，17)	8(3，12)	5(4, 6)	2(1, 3)
Z值		0.201	5.116	0.840	3.986
P值		0.764	< 0.001	0.401	< 0.001

下载: 导出CSV

表 5 2组心脏外科术后患者机械通气、ICU停留及住院时间比较

Table 5. Comparison of mechanical ventilation time, ICU staytime and hospitalization time after cardiac surgerybetween the two groups

组别	例数	机械通气时间 [M(P₂₅, P₇₅)，h]	ICU停留时间 (x±s，d)	住院时间 [M(P₂₅, P₇₅)，d]
对照组	60	65.8(36.9，78.4)	7.26±2.25	31.5(21.3，38.7)
观察组	60	42.7(20.4，43.1)	4.31±2.77	24.5(17.2，29.4)
统计量		9.434^a	6.403^b	3.167^a
P值		< 0.001	< 0.001	0.002
注：^a为Z值，^b为t值。

下载: 导出CSV

参考文献(18)

[1]	VLISIDES P, AVIDAN M. Recent advances in preventing and managing postoperative delirium[J]. F1000Res, 2019, 8(1): F1000. DOI: 10.12688/f1000research.16780.1.
[2]	王伟, 刘丹丹, 李志朋. 老年心脏术后谵妄的研究进展[J]. 保健医学研究与实践, 2021, 18(S1): 271-273. https://www.cnki.com.cn/Article/CJFDTOTAL-GXBJ2021S1091.htm WANG W, LIU D D, LI Z P. Research progress of postoperative delirium in the elderly[J]. Health Medicine Research and Practice, 2021, 18(S1): 271-273. https://www.cnki.com.cn/Article/CJFDTOTAL-GXBJ2021S1091.htm
[3]	STOLLINGS J L, KOTFIS K, CHANQUES G, et al. Delirium in critical illness: clinical manifestations, outcomes, and management[J]. Intensive Care Med, 2021, 47(10): 1089-1103. doi: 10.1007/s00134-021-06503-1
[4]	LUETZ A, GRUNOE J J, MÖRGELI R, et al. Innovative ICU solutions to prevent and reduce delirium and post-intensive care unit syndrome[J]. Semin Respir Crit Care Med, 2019, 40(5): 673-686. doi: 10.1055/s-0039-1698404
[5]	朱红艳, 徐维昉. 基于ERAS理念的麻醉苏醒期护理对老年髋部骨折全麻手术患者术后谵妄的影响[J]. 中华全科医学, 2022, 20(3): 519-522. doi: 10.16766/j.cnki.issn.1674-4152.002391 ZHU H Y, XU W F. Influence of anaesthesia recovery nursing based on enhanced recovery after surgery on post-operative delirium in elderly patients under general anaesthesia for hip fracture surgery[J]. Chinese Journal of General Practice, 2022, 20(3): 519-522. doi: 10.16766/j.cnki.issn.1674-4152.002391
[6]	宋亚敏, 杨满青, 凌云, 等. 重症监护室预防谵妄的护理干预方案在心脏外科术后患者中的应用[J]. 中国护理管理, 2022, 22(4): 507-511. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202204006.htm SONG Y M, YANG M Q, LING Y, et al. Effects of Nursing Delirium Preventive Interventions in the Intensive Care Unit on delirium management in patients after cardiac surgery[J]. Chinese Nursing Management, 2022, 22(4): 507-511. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202204006.htm
[7]	范洁, 张建平, 刘春霞, 等. 集束化护理干预对老年痴呆患者谵妄的预防效果研究[J]. 保健医学研究与实践, 2022, 19(01): 114-117. https://www.cnki.com.cn/Article/CJFDTOTAL-GXBJ202201025.htm FAN J, ZHANG J P, LIU C X, et al. A study on the effectiveness of care bundle intervention on the prevention of delirium in alzheimer's patients[J]. Health Medicine Research and Practice, 2022, 19(01): 114-117. https://www.cnki.com.cn/Article/CJFDTOTAL-GXBJ202201025.htm
[8]	杨磊, 张茂. 2013年美国ICU成年患者疼痛、躁动和谵妄处理指南[J]. 中华急诊医学杂志, 2013, 22(12): 1325-1326. doi: 10.3760/cma.j.issn.1671-0282.2013.12.004 YANG L, ZHANG M. Guidelines for the treatment of pain, restlessness and delirium in adult patients in the US ICU in 2013[J]. Chinese Journal of Emergency Medicine, 2013, 22(12): 1325-1326. doi: 10.3760/cma.j.issn.1671-0282.2013.12.004
[9]	刘思伯, 刘赞华, 王虹, 等. 老年患者首次谵妄发生后的预后相关因素分析[J]. 中华老年医学杂志, 2019, 38(2): 161-164. doi: 10.3760/cma.j.issn.0254-9026.2019.02.011 LIU S B, LIU Z H, WANG H, et al. Analysis of prognosis-relating factors in the elderly patients after the initial onset of delirium[J]. Chinese Journal of Geriatrics, 2019, 38(2): 161-164. doi: 10.3760/cma.j.issn.0254-9026.2019.02.011
[10]	路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学, 2014, 43(3): 260-263. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201403002.htm LU T Y, LI Y, XIA P, et al. Analysis on reliability and validity of the Pittsburgh sleep quality index[J]. Chongqing Medicine, 2014, 43(3): 260-263. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201403002.htm
[11]	李青栋, 万献尧. 机械通气患者的疼痛评估与镇痛策略演变[J]. 中华危重病急救医学, 2017, 29(9): 861-864. LI Q D, WAN X Y. Progress of pain assessment and analgesia strategy for mechanical ventilation patients[J]. Chinese Critical Care Medicine, 2017, 29(9): 861-864.
[12]	陈佳佳, 童莺歌, 黎晓艳, 等. 中文版行为疼痛评估工具的研究进展[J]. 护理研究, 2017, 31(32): 4043-4047. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201732002.htm CHEN J J, TONG Y G, LI X Y, et al. Research progress on Chinese version of behavior pain assessment tool[J]. Chinese Nursing Research, 2017, 31(32): 4043-4047. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201732002.htm
[13]	XAVIER I B M, BISCARRA V B, PICCOLI Â B, et al. Nursing guidelines on cardiac surgery and parents' anxiety: randomized clinical trial[J]. Braz J Cardiovasc Surg, 2020, 35(4): 437-444. http://www.xueshufan.com/publication/3045209320
[14]	陈国庆, 徐娟, 宋秀银, 等. ICU谵妄危险因素及集束化干预预防措施[J]. 国际护理学杂志, 2021, 40(15): 2716-2719. CHEN G Q, XU J, SONG X Y, et al. Risk factors of delirium in ICU and cluster intervention and prevention measures[J]. International Journal of Nursing, 2021, 40(15): 2716-2719.
[15]	周家梅, 徐晓君, 钟威, 等. ABCDE集束化护理措施在心脏瓣膜置换术后谵妄患者中的应用及效果观察[J]. 护士进修杂志, 2021, 36(16): 1489-1492. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202116011.htm ZHOU J M, XU X J, ZHONG W, et al. Application and effect observation of ABCDE cluster nursing measures in patients with delirium after cardiac valve replacement[J]. Journal of Nurses Training, 2021, 36(16): 1489-1492. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202116011.htm
[16]	MEGJHANI M, TERILLI K, KAPLAN A, et al. Use of clustering to investigate changes in intracranial pressure waveform morphology in patients with ventriculitis[J]. Acta Neurochir Suppl, 2021, 131: 59-62. doi: 10.1007/978-3-030-59436-7_13
[17]	CHEN H Y, MO L, HU H J, et al. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis[J]. J Cardiothorac Surg, 2021, 16(1): 113. http://doc.paperpass.com/foreign/rgArti2021406210091.html
[18]	刘娟, 刘薇萍, 喻欣, 等. 应用ABCDE集束化管理预防ICU患者谵妄的研究进展[J]. 中国实用护理杂志, 2018, 34(9): 716-720. LIU J, LIU W P, YU X, et al. Prevention of delirium in ICU patients: ABCDE bundle management[J]. Chinese Journal of Practical Nursing, 2018, 34(9): 716-720.