预防术后谵妄
Preventing postoperative delirium.
作者信息
Kratz Torsten, Heinrich Manuel, Schlauß Eckehard, Diefenbacher Albert
机构信息
Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus "Königin Elisabeth" Herzberge, Berlin.
出版信息
Dtsch Arztebl Int. 2015 Apr 24;112(17):289-96. doi: 10.3238/arztebl.2015.0289.
BACKGROUND
Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients with pre-existing cognitive deficits.
METHODS
In an open study, we systematically assessed the frequency of postoperative delirium in patients over age 70 on two surgical wards of a general hospital. In a six-month "prevalence phase," from March to August 2011, we counted the number of patients with postoperative delirium, but did not initiate any intervention. Thereafter, in a ten-month "intervention phase" from September 2011 to June 2012, a nurse with special training in the management of delirium carried out an intervention involving component measures of the Hospital Elder Life Program (HELP) on one of the two wards, with the aim of preventing postoperative delirium. The patients on the other ward served as a control group.
RESULTS
In the prevalence phase, 20.2% of all patients developed postoperative delirium (95% confidence interval [CI], 14.6-26.4). In the intervention phase, postoperative delirium arose in 20.8% (95% CI, 11.3-32.1) of the patients on the ward with no specific interventions, but in only 4.9% (95% CI, 0.0-11.5) of those on the ward where the intervention was carried out. The difference was presumably due to the measures initiated by the specially trained nurse, including validation, improvement of sleep, cognitive activation, early mobilization, improved sensory stimulation, and improved nutritional and fluid intake. Important predictors of postoperative delirium included a low score on the Mini-Mental State Examination, advanced age, and preoperative infection.
CONCLUSION
The frequency of postoperative delirium in elderly patients with cognitive deficits can be lowered with nursing measures carried out by a specially trained nurse, close postoperative supervision, and cognitive activation.
背景
谵妄是老年住院患者常见的并发症。它会延长住院时间，增加费用，加重护理人员的工作量，并且可能需要将患者转至疗养院。术前存在认知缺陷的老年患者术后发生谵妄的风险尤其高。
方法
在一项开放性研究中，我们系统评估了一家综合医院两个外科病房中70岁以上患者术后谵妄的发生率。在2011年3月至8月的为期6个月的“患病率阶段”，我们统计了术后发生谵妄的患者数量，但未采取任何干预措施。此后，在2011年9月至2012年6月的为期10个月的“干预阶段”，一名接受过谵妄管理特殊培训的护士在两个病房中的一个实施了一项涉及医院老年生活计划（HELP）组成措施的干预，旨在预防术后谵妄。另一个病房的患者作为对照组。
结果
在患病率阶段，所有患者中有20.2%发生了术后谵妄（95%置信区间[CI]，14.6 - 26.4）。在干预阶段，未进行特定干预的病房中20.8%（95%CI，11.3 - 32.1）的患者发生了术后谵妄，但在实施干预的病房中仅4.9%（95%CI，0.0 - 11.5）的患者发生了术后谵妄。差异可能归因于受过特殊培训的护士采取的措施，包括确认、改善睡眠、认知激活、早期活动、改善感觉刺激以及改善营养和液体摄入。术后谵妄的重要预测因素包括简易精神状态检查表得分低、高龄和术前感染。
结论
通过受过特殊培训的护士实施护理措施、术后密切监测和认知激活，可以降低认知缺陷老年患者术后谵妄的发生率。
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