Kim Hyo Jin, Kim Dong Hee
Child Health Nurs Res. 2019 Apr;25(2):103-111. doi: 10.4094/chnr.2019.25.2.103. Epub 2019 Apr 30.
This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors.
The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, test, t-test, and logistic regression analyses.
The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age ( =14.10, =.007), admission type ( =7.40, =.007), use of physical restraints ( =26.11, <.001), RASS score ( =14.80, =.001), need for oxygen ( =5.31, =.021), use of a mechanical device ( =9.97, =.041), feeding ( =7.85, =.005), and the presence of familiar objects ( =29.21, <.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.1645.95, <.001) and the presence of familiar objects (OR=0.09, 95% CI=0.030.30, =.002).
Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
本研究旨在调查儿科重症监护病房(PICU)中谵妄的发生率,并分析相关危险因素。
研究对象为95例年龄从新生儿至18岁入住PICU的患者。所使用的工具为里士满躁动镇静量表(RASS)和康奈尔儿科谵妄评估量表。数据分析采用描述性分析、卡方检验、t检验和逻辑回归分析。
入住PICU的儿童谵妄发生率为42.1%。根据年龄(χ² = 14.10,P = 0.007)、入院类型(χ² = 7.40,P = 0.007)、使用身体约束(χ² = 26.11,P < 0.001)、RASS评分(χ² = 14.80,P = 0.001)、是否需要吸氧(χ² = 5.31,P = 0.021)、是否使用机械设备(χ² = 9.97,P = 0.041)、喂养情况(χ² = 7.85,P = 0.005)以及是否有熟悉物品(χ² = 29.21,P < 0.001)存在显著差异。与谵妄诊断相关的因素为使用身体约束(比值比[OR] = 13.82,95%置信区间[CI] = 4.1645.95,P < 0.001)和有熟悉物品(OR = 0.09,95% CI = 0.030.30,P = 0.002)。
应积极进行定期的谵妄评估和干预。应尽可能减少约束的使用。护理人员应让儿童周围有熟悉的物品,并确保为儿童营造一个友好且适宜的医院环境。