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Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium.危重症患儿的谵妄与死亡率:小儿谵妄的流行病学及转归
Crit Care Med. 2017 May;45(5):891-898. doi: 10.1097/CCM.0000000000002324.
2
Outcome of delirium in critically ill patients: systematic review and meta-analysis.危重症患者谵妄的结局:系统评价与荟萃分析。
BMJ. 2015 Jun 3;350:h2538. doi: 10.1136/bmj.h2538.
3
Pediatric delirium and associated risk factors: a single-center prospective observational study.小儿谵妄及相关危险因素:一项单中心前瞻性观察性研究。
Pediatr Crit Care Med. 2015 May;16(4):303-309. doi: 10.1097/PCC.0000000000000356.
4
Sedation and delirium in the intensive care unit.重症监护病房中的镇静与谵妄
N Engl J Med. 2014 Jan 30;370(5):444-54. doi: 10.1056/NEJMra1208705.
5
Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*.康奈尔儿科意识障碍评估量表:一种有效、快速、观察性的工具,用于筛查 PICU 中的谵妄*。
Crit Care Med. 2014 Mar;42(3):656-63. doi: 10.1097/CCM.0b013e3182a66b76.
6
Implementing delirium screening in the ICU: secrets to success.在 ICU 中实施谵妄筛查:成功的秘诀。
Crit Care Med. 2013 Sep;41(9):2196-208. doi: 10.1097/CCM.0b013e31829a6f1e.
7
Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.成人重症监护病房疼痛、躁动和谵妄管理的临床实践指南。
Crit Care Med. 2013 Jan;41(1):263-306. doi: 10.1097/CCM.0b013e3182783b72.
8
[The effects of pre-operative visual information and parental presence intervention on anxiety, delirium, and pain of post-operative pediatric patients in PACU].[术前视觉信息与家长陪伴干预对小儿患者术后在麻醉后监护室的焦虑、谵妄及疼痛的影响]
J Korean Acad Nurs. 2012 Jun;42(3):333-41. doi: 10.4040/jkan.2012.42.3.333.
9
Symptom profile of delirium in children and adolescent--does it differ from adults and elderly?儿童和青少年谵妄的症状特征——与成人和老年人有何不同?
Gen Hosp Psychiatry. 2012 Nov-Dec;34(6):626-32. doi: 10.1016/j.genhosppsych.2012.03.003. Epub 2012 Apr 18.
10
Pediatric delirium in the pediatric intensive care unit: a systematic review and an update on key issues and research questions.儿科重症监护病房中的儿童谵妄:系统评价及关键问题和研究问题更新。
Minerva Anestesiol. 2011 Nov;77(11):1099-107. Epub 2011 May 26.

[儿科重症监护病房中与儿童谵妄相关的因素]

[Factors associated with Pediatric Delirium in the Pediatric Intensive Care Unit].

作者信息

Kim Hyo Jin, Kim Dong Hee

出版信息

Child Health Nurs Res. 2019 Apr;25(2):103-111. doi: 10.4094/chnr.2019.25.2.103. Epub 2019 Apr 30.

DOI:10.4094/chnr.2019.25.2.103
PMID:35004403
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8650920/
Abstract

PURPOSE

This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

目的

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。

方法

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。

结果

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)。

结论

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。