护理学报 ›› 2022, Vol. 29 ›› Issue (10): 39-42.doi: 10.16460/j.issn1008-9969.2022.10.039
ICU患者谵妄严重程度分级的研究进展
孙建华, 李奇, 谢铃莉, 赵明曦, 李鑫, 马鸿鸣, 万朝阳, 王新博, 王小亭
- 中国医学科学院北京协和医院 重症医学科,北京 100730
摘要： 目的 梳理ICU患者谵妄严重程度的国内外研究现状,为临床护理工作提供借鉴。方法 检索国内外相关文献,从ICU患者谵妄严重程度的相关概念、国内外研究现状、ICU谵妄严重程度常用的评估工具及重症患者谵妄治疗理念的转变等方面进行综述。结果 谵妄的严重程度与ICU患者较高的死亡率增加、长期认知功能下降相关;谵妄严重程度的判定不仅关注不同症状表现强度的总和,而且需要谵妄症状持续的时间;医务人员在运用谵妄严重程度评估工具时应掌握谵妄的核心症状群,明确工具应用的优缺点。结论 ICU患者谵妄严重程度的评估,促使量化分级评价谵妄,有助于科学的制定与实施谵妄管理方案,实时监测治疗效果与并发症,促进患者康复。
中图分类号:
- R473
| [1] 王小亭,汤铂,刘大为. 重症谵妄:一个古老传说的新篇章[J]. 中华内科杂志, 2019,58(2):83-84.DOI:10.3760/cma.j.issn.0578-1426.2019.02.002. [2] Lindroth H, Khan BA, Carpenter JS, et al.Delirium Severity Trajectories and Outcomes in ICU Patients. Defining a Dynamic Symptom Phenotype[J]. Ann Am Thorac Soc,2020,17(9):1094-1103.DOI:10.1513/AnnalsATS.201910-764OC. [3] Schulman-Green D, Schmitt EM, Fong TG, et al.Use of an Expert Panel to Identify Domains and Indicators of Delirium Severity[J]. Qual Life Res,2019,28(9):2565-2578.DOI:10.1007/s11136-019-02201-0. [4] 隋伟静,庄一渝,陈香萍,等. 住院患者谵妄严重度评估工具及临床应用的研究进展[J].中华急危重症护理杂志,2021, 2(5):454-459.DOI:10.3761/j.issn.2096-7446.2021.05.013. [5] Stollings JL, 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. [6] Rosgen BK, Krewulak KD, Stelfox HT, et al.The Association of Delirium Severity with Patient and Health System Outcomes in Hospitalised Patients: A Systematic Review[J]. Age Ageing,2020,49(4):549-557.DOI:10.1093/ageing/afaa053. [7] Kimchi EY, Neelagiri A, Whitt W, et al.Clinical EEG Slowing Correlates with Delirium Severity and Predicts Poor Clinical Outcomes[J]. Neurology,2019,93(13):e1260-e1271.DOI:10.1212/WNL.0000000000008164. [8] Jones RN, Cizginer S, Pavlech L, et al.Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review[J]. JAMA Intern Med,2019,179(2):231-239.DOI:10.1001/jamainternmed.2018.6975. [9] Gross AL, Tommet D, D'Aquila M, et al. Harmonization of Delirium Severity Instruments: A Comparison of the Drs-R-98, Mdas, and Cam-S Using Item Response Theory[J]. BMC Med Res Methodol,2018,18(1):92.DOI:10.1186/s12874 -018-0552-4 [10] Wintermann GB, Weidner K, Strauss B, et al.Single Assessment of Delirium Severity During Postacute Intensive Care Of Chronically Critically Ill Patients and Its Associated Factors:Post Hoc Analysis of a Prospective Cohort Study In Germany[J]. BMJ Open, 2020,10(10):e35733.DOI:10.1136/bmjopen-2019-035733 [11] Khan SH, Lindroth H, Perkins AJ, et al.Delirium Incidence, Duration, And Severity in Critically Ill Patients with Coronavirus Disease 2019[J]. Critical Care Explorations,2020,2(12):e290.DOI:10.1097/CCE.0000000000000290. [12] Sakuramoto H, Subrina J, Unoki T, et al.Severity of Delirium in the ICU Is Associated with Short Term Cognitive Impairment. A Prospective Cohort Study[J]. Intensive Crit Care Nurs,2015,31(4):250-257.DOI:10.1016/j.iccn.2015.01.001. [13] Khan BA, Perkins AJ, Prasad NK, et al.Biomarkers of Delirium Duration and Delirium Severity in the ICU[J]. Crit Care Med, 2020, 48(3):353-361.DOI:10.1097/CCM.0000000000004139. [14] 吴宇洁,石中永,王美娟,等. 记忆谵妄评定量表中文版测评老年术后患者的效度和信度[J].中国心理卫生杂志,2014,28(12):937-941.DOI:10.3969/j.issn.1000-6729.2014.12.011. [15] 孙丹丹,柴文昭,郭海凌,等. 不同类型谵妄在机械通气患者中的发生现状及临床结局比较[J]. 中华护理杂志,2018, 53(7):778-782.DOI:10.3761/j.issn.0254-1769.2018.07.002. [16] 汤铂,王小亭,陈文劲,等.重症患者谵妄管理专家共识[J]. 中华内科杂志,2019,58(2):108-118. [17] Khan BA, Perkins AJ, Gao S, et al.The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU[J]. Crit Care Med,2017,45(5):851-857.DOI:10.1097/CCM.0000000000002368. [18] Wei LA, Fearing MA, Sternberg EJ, et al.The Confusion Assessment Method: A Systematic Review of Current Usage[J]. J Am Geriatr Soc, 2008,56(5):823-830.DOI:10.1111/j.1532-5415.2008.01674.x [19] Inouye SK, Kosar CM, Tommet D, et al.The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts[J]. Ann Intern Med, 2014,160(8):526-533.DOI:10.7326/M13-1927 [20] 赵巍,周挺,王弋,等. ICU谵妄患者时间定向护理效果探讨[J]. 护理学杂志,2014,29(19):42-43.DOI:10.3870/hlxzz.2014.19.042. [21] 唐艳艳. 地氟烷与丙泊酚对老年患者应激反应及术后谵妄的影响[D]. 衡阳:南华大学,2020. [22] Krewulak KD, Rosgen BK, Ely EW, et al.The CAM-ICU-7 and ICDSC as Measures of Delirium Severity in Critically Ill Adult Patients[J]. PloS one, 2020,15(11):e242378.DOI:10.1371/journal.pone.0242378. [23] Osse RJ, Tulen JH, Hengeveld MW, et al.Screening Methods for Delirium: Early Diagnosis by Means of Objective Quantification of Motor Activity Patterns Using Wrist-Actigraphy[J]. Interact Cardiovasc Thorac Surg,2009,8(3):344-348.DOI:10.1510/icvts.2008.192278. [24] van Sleuwen M, Sun H, Eckhardt C, et al. Physiological Assessment of Delirium Severity: The Electroencephalographic Confusion Assessment Method Severity Score(E-CAM-S)[J]. Crit Care Med,2022, 50(1):e11-e19.DOI:10.1097/CCM.0000000000005224. [25] Balas MC, Vasilevskis EE, Burke WJ, et al.Critical Care Nurses' Role in Implementing the “Abcde Bundle” into Practice[J]. Crit Care Nurse,2012, 32(2):35-38.DOI:10.4037/ccn2012229 [26] Wang XT, Lin L, Tang B, et al.Delirium in Intensive Care Unit Patients: Ten Important Points of Understanding[J]. Chin Med J(Engl),2017,130(20):2498-2502. [27] Vincent JL, Shehabi Y, Walsh TS, et al.Comfort and Patient-centred Care without Excessive Sedation: The Ecash Concept[J]. Intensive Care Med,2016,42(6):962-971.DOI:10.1007/s00134-016-4297-4. [28] Weber C, Fierz K, Katapodi M, et al.An Advanced Practice Nurse-led Delirium Consultation Service Reduces Delirium Severity and Length of Stay in Orthopedic Patients: A Nonrandomized Posttest Only Evaluation Study[J]. Perspect Psychiatr Care,2020, 56(4):804-810.DOI:10.1111/ppc.12495. [29] 骆艳妮,王秀莹,王小闯,等. ESCAPE策略在机械通气患者谵妄管理的应用[J]. 护理学杂志,2019,34(19):37-40.DOI:10.3870/j.issn.1001-4152.2019.19.037. [30] 张爱琴,陈俊杉,余金甜. ICU患者谵妄非药物管理相关指南的系统评价[J]. 护理学报,2020,27(11):26-32.DOI:10.16460/j.issn1008-9969.2020.11.026. [31] 陈俊杉,余金甜,赵思雨,等. ICU患者谵妄风险预测模型研究进展[J]. 护理学报,2019,26(5):15-19.DOI:10.16460/j.issn1008-9969.2019.05.015. [32] Flannery AH, Oyler DR, Weinhouse GL.The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework[J]. Crit Care Med,2016, 44(12):2231-2240.DOI:10.1097/CCM.0000000000001952. [33] Mikkelsen ME, Still M, Anderson BJ, et al.Society of Critical Care Medicine's International Consensus Conference on Prediction and Identification of Long-term Impairments after Critical Illness[J]. Crit Care Med,2020,48(11):1670-1679.DOI:10.1097/CCM.0000000000004586. [34] Vasunilashorn SM, Marcantonio ER, Gou Y, et al.Quantifying the Severity of a Delirium Episode Throughout Hospitalization: The Combined Importance of Intensity and Duration[J]. J Gen Intern Med,2016,31(10):1164-1171.DOI:10.1007/s11606-016-3671-9. |
| [1] | 邱昌翠, 于晓丽, 冯亚婷, 杨正雄, 徐婷, 朱晓萍. ICU营养支持患者再喂养综合征风险评估及预防干预研究[J]. 护理学报, 2022, 29(7): 57-62. |
| [2] | 米元元, 黄海燕, 陈卉, 陈汉珍, 明耀辉, 聂涛. 重症患者非计划重返ICU安全管理方案的建立及效果评价[J]. 护理学报, 2022, 29(6): 15-19. |
| [3] | 邓瑛瑛, 裴华清, 文梅, 殷春梅, 张小玲. 神经外科重症患者PICC相关性血栓物理预防的最佳证据总结[J]. 护理学报, 2021, 28(8): 28-32. |
| [4] | 陈俊杉, 范杰梅, 余金甜, 张爱琴. 神经外科ICU患者谵妄风险预测模型的构建与验证[J]. 护理学报, 2021, 28(4): 1-8. |
| [5] | 严玉娇, 丁娟, 刘晁含, 付沫, 王虹. 成人危重症患者气道管理的最佳证据总结[J]. 护理学报, 2021, 28(3): 39-45. |
| [6] | 郭汉画, 陈名桂, 孔丽丽, 张晓璇. 重症患者动脉测压导管最佳更换策略的循证实践[J]. 护理学报, 2021, 28(2): 37-41. |
| [7] | 张玉坤, 王钰炜, 王飒, 闫丹萍, 陈水红. 成人ICU患者疼痛管理的最佳证据总结[J]. 护理学报, 2021, 28(11): 40-45. |
| [8] | 秦鸿利, 赵震, 王艳芳, 卢颖, 王志霞, 李黎明. ICU患者压力性损伤预防的最佳证据总结[J]. 护理学报, 2021, 28(10): 45-51. |
| [9] | 吴溢涛, 王晓容, 潘文彦, 李菁菁, 钱晨. 分级色块管理方案在危重症患者院内转运中的应用及效果评价[J]. 护理学报, 2021, 28(10): 17-23. |
| [10] | 赵明曦, 孙建华, 李若祎, 侯锦, 李尊柱, 罗红波, 奉爱萍, 李欣, 李奇. 床旁超声在重症患者肠内营养的应用进展[J]. 护理学报, 2021, 28(1): 17-21. |
| [11] | 李荣华, 于红静, 黄敬烨, 刘晓青, 周英, 黎毅敏. ICU患者主要照顾者3个时间点睡眠质量影响因素研究[J]. 护理学报, 2021, 28(1): 51-56. |
| [12] | 米元元, 李巧云, 明耀辉, 王婷, 庞志强, 胡恩华, 聂涛, 陈卉, 黄海燕. 1例危重型新型冠状病毒肺炎合并ARDS患者的成功救护[J]. 护理学报, 2020, 27(9): 64-67. |
| [13] | 李曼, 薛秀娟. 山东省50家二级及以上医院1 014名ICU护士对危重患者肠内喂养障碍的现状分析[J]. 护理学报, 2020, 27(5): 39-41. |
| [14] | 明耀辉, 米元元, 聂涛, 向成林, 黄海燕, 袁世荧. ICU新型冠状病毒感染防控管理体系的建立及成效[J]. 护理学报, 2020, 27(5): 55-59. |
| [15] | 张煜, 张春艳, 金玉, 王淑芹, 董亮, 万娜, 贾燕瑞, 高凤莉. 内科危重症患者深静脉血栓预防审查指标的制定及障碍因素分析[J]. 护理学报, 2020, 27(4): 37-41. |
|
||