集束化护理和常规护理对老年口腔癌患者术后谵妄的影响

摘要/Abstract

摘要： 目的:探讨针对危险因素的集束化护理对老年口腔癌患者术后谵妄的影响。方法:选择160例择期全身麻醉下行口腔癌根治手术的老年患者,随机分为常规护理组（R组）和集束化护理组（I组）。在围术期,常规护理组给予常规指导和护理,集束化护理组在此基础上给予针对术后谵妄危险因素的特殊护理措施,如护理教育、心理护理、认知刺激、早期活动、维持睡眠觉醒周期等个体化护理措施。使用RASS镇痛躁动评分、CAM-ICU谵妄评估、VAS疼痛评分和QoR40恢复质量评分等进行动态监测。采用SPSS16.0软件包对数据进行统计学分析。结果:2组患者基本情况无显著差异。I组患者术后RASS评分和QoR40评分好于R组,并且术后谵妄的发生率和持续时间降低。2组患者术后VAS评分无显著差异。结论:针对危险因素的集束化护理可以改善患者术后镇静躁动评分,减少术后谵妄的发生。

关键词: 术后谵妄, 老年患者, 口腔癌, 护理

Abstract: PURPOSE: To investigate the impact of care bundles against risk factors on postoperative delirium in elderly oral cancer patients. METHODS: One hundred and sixty elderly oral cancer patients who were planned to undergo tumor resection surgery were selected, and subsequently randomly divided into 2 groups: group R and group I. During the perioperative period, group R received regular guidance and care, while group I was given care bundles based on regular care, which was aimed at the risk factors of postoperative delirium. Care bundles comprised of several special individualized care measures such as nursing education, psychological care, cognitive stimulation, early activity, maintaining the sleep-wake cycle and etc. At the same time, RASS, CAM-ICU, VAS scale and QoR40 scores were dynamically monitored. All statistical analysis was performed by using SPSS16.0 software package. RESULTS: There was no significant difference between the 2 groups in general characteristics. RASS scores and QoR40 scares during the three postoperative days in group I were better than group R; moreover, the incidences and duration of postoperative delirium in group I were less than group R. No significant difference was seen in VAS scores between the 2 groups. CONCLUSIONS: Care bundles against risk factors on postoperative delirium in elderly oral cancer patients could ameliorate RASS scores and decrease postoperative delirium.

Key words: Postoperative delirium, Elderly patients, Oral cancer, Nursing care

中图分类号:

R473.98

张燕, 殷琦, 李燕, 倪莹, 孙璐璐, 郭勇. 集束化护理和常规护理对老年口腔癌患者术后谵妄的影响[J]. 中国口腔颌面外科杂志, 2016, 14(2): 162-166.

ZHANG Yan, YIN Qi, LI Yan, NI Ying, SUN Lu-lu, GUO Yong. Impact of care bundles and usual care on postoperative delirium in elderly oral cancer patients[J]. China J Oral Maxillofac Surg, 2016, 14(2): 162-166.

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