eCASH护理模式对老年病人髋部术后谵妄的影响
Effect of eCASH nursing model on postoperative delirium in elderly patients with hip surgery
-
摘要: 目的:探讨eCASH护理模式对老年髋部病人术后谵妄发生的影响。方法:将2016年8-11月骨科收治的30例老年髋部手术病人作为对照组;2016年12月至2017年3月收治的32例老年髋部病人作为观察组。对照组行常规骨科术后护理,观察组实施eCASH护理管理,术后3 d内护士每天运用Nu-DESC评估,比较2组病人术后发生谵妄情况、2组病人不同时间点疼痛视觉模拟(VAS)评分、2组病人住院时间及2组病人术后恶心呕吐、非计划拔管等不良反应发生率。结果:2组病人术前均有不同程度疼痛,但差异无统计学意义(P>0.05),2组术前均无谵妄,2组病人术后不同时点(术后24 h、48 h、72 h)谵妄程度评分比较,观察组术后发生谵妄程度明显低于对照组(P<0.01),观察组术后不同时间点VAS评分均明显低于对照组(P<0.01);2组住院时间对比,观察组住院时间明显低于对照组(P<0.01);2组病人术后恶心呕吐及非计划拔管等不良反应发生率观察组明显低于对照组(P<0.01)。结论:对老年髋部病人术后实施eCASH护理模式,早期给予有效的镇痛,一切以病人的舒适为中心,有利于减低老年髋部病人术后谵妄发生,降低老年髋部术后病人住院时间,减少老年髋部病人术后恶心呕吐及非计划拔管等不良反应的发生率,为预防老年髋部病人术后并发症提供有效依据。Abstract: Objective:To investigate the effects of eCASH nursing model on postoperative delirium in elderly patients with hip surgery.Methods:Thirty elderly patients with hip surgery from August to November in 2016 and 32 elderly patients with hip surgery from December 2016 to March in 2017 were divided into the control group and observation group,respectively.The control group and observation group were treated with the routine postoperative nursing and eCASH nursing management,respectively.All cases were evaluated using Nu-DESC within postoperative 3 days.The delirious state,VAS scores at different time-points,hospitalization time,and incidence rates of nausea and vomitting and unplanned extubation between two groups were compared after operation.Results:The different degrees of pain in two groups were identified before operation,but the difference of which was not statistically significant(P>0.05).There was no delirium in the 2 groups before operation.The delirious scores in observation group after 24,48 and 72 hours of operation were significantly lower than those in control group(P<0.01).The VAS scores at different time-points of postoperation,hospitalization time and incidence rates of nausea and vomitting and unplanned extubation in observation group were significantly lower than those in control group(P<0.01).Conclusions:The eCASH nursing model and early effective analgesia can effectively reduce the occurrence of postoperative delirium,hospitalization time and incidence rates of postoperative nausea and vomiting and unplanned extubation,which can provide the effective basis in preventing the postoperative complications in elderly patients with hip surgery.
-
Key words:
- postoperative delirium /
- hip surgery /
- eCASH
-
[1] MENICOLL L,BESDINE RW.The future of delirium research:promising but still room for improvement[J].Aging Clin Exp,2007(19):169. [2] 梁春来,张音.老年人髋部骨折术后谵妄的原因分析和治疗[J].浙江中医药大学学报,2008,32(5):631. [3] CULP KR,CACCHIONE PZ.Nutritional status and delirium in longterm care elderly individuals[J].Appl Nurs Res,2008,21(2):66. [4] 诸葛军,熊良平.老年髋部骨折术后谵妄的危险因素分析[J].浙江临床医学,2016,18(8):1463. [5] 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. [6] 王春立,吴瑛,岳鹏,等.护士使用的谵妄评估工具研究现状[J].中华护理杂志,2009,44(10):950. [7] 毛敦.髋部骨折高龄患者为手术期谵妄临床分析[J].现代医院,2012,12(12):24. [8] 高小燕.老年髋部骨折患者术后谵妄的危险因素及护理对策[J/CD].中华老年骨科与康复电子杂志,2015,1(1):59. [9] RUDOLPH JL,MARCANTONIO ER.Review articles:postoperative delirium:acute change with long-term implications[J].Anesth Analg,2011,112(5):1202. [10] DEO H,WEST G,BUTCHER C,et al.The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement[J].Kenn,2011,18(2):117. [11] 刘婧,樊秀丽.术后硬膜外自控镇痛并发症的观察及护理[J].中国疼痛医学杂志,2017,23(1):64. [12] 胡杏平,张庆霞,彭苑妮,等.疼痛管理对骨科髋部骨折高龄患者术后谵妄的影响研究[J].医学信息,2012,25(12):76. [13] 王宁,史妙,王锦琰,等.疼痛的心理学治疗方法[J].中华护理杂志,2009,44(7):670. [14] 张国荣.术后疼痛的危害及其治疗[J].空军医学杂志,2000,16(3):165. [15] 赵丽霞,郭瑞友.老年性谵妄的研究现状[J].中国临床保健杂志,2008,11(4):442. [16] 任艳萍,蔡焯基,马辛,等.老年性谵妄临床特征及相关因素分析[J].中国神经精神疾病杂志,2000,26(5):268. [17] 王彬,张其亮,李军,等.老年患者髋关节置换术后谵妄和认知功能障碍的危险因素[J].临床麻醉学杂志,2013,29(8):785. [18] 张承华,麻伟青,杨云丽,等.高龄患者髋关节置换术后谵妄的发生率及危险因素分析[J].临床麻醉学杂志,2011,27(5):455.
计量
- 文章访问数: 3123
- HTML全文浏览量: 284
- PDF下载量: 121
- 被引次数: 0