ICU高龄患者脊柱术后谵妄危险因素分析及护理干预.docVIP

ICU高龄患者脊柱手术后谵妄危险因素分析及护理干预 　　[摘要] 目的 分析术后谵妄发生情况及相关危险因素，为临床护理提供指导。 方法 选择2013年1月～2015年8月我科收治的70例高龄脊柱手术治疗后转入ICU监护治疗的患者。采用ICU意识错乱评估方法（CAM-ICU）进行评估，收集患者相关资料，分析术后谵妄发生率及相关危险因素。 结果 70例患者中，男32例，女38例；平均年龄（70.1±5.8）岁；转入ICU时33例未拔出气管插管，37例已拔出。共有17例（24.3%）患者出现谵妄，平均发生时间为术后（1.5±0.9）d。谵妄组平均年龄较大（P=0.03），术前平均住院日较长（P=0.03）。手术时间及术中输液量大于非谵妄组（P=0.02， P=0.01）；术后第2、3天钠离子、氯离子较低，第3天钾离子较低，差异有统计学意义（P中国论文网 /1/viewhtm 　　[关键词] 术后谵妄；脊柱手术；护理干预 　　[中图分类号] R473.6 [文献标识码] B [文章编号] 2095-0616（2016）01-109-04 　　[Abstract] Objective To analyze the occurrence condition of postoperative delirium， to provide guidance for clinical nursing. Methods To select 70 elderly patients who were received and treated with spinal surgery， and then were transferred to ICU in our hospital from January 2013 to August 2015. To select and evaluate on patients related data adopt by ICU confusion assessment method （CAM-ICU）， to analyze the incidence of postoperative delirium and related risk factors. Results Of the 70 patients of male 32 cases and female 38 cases with the average age of （70.1±5.8） years， there were 33 cases tracheal intubation non-pullout and 37 cases tracheal intubation pullout when the patients were transferred to ICU. There were 17 patients（24.3%） had appeared postoperative delirium with the average occurrence time of （1.5±0.9） days. The average age was older（P=0.03）， the preoperative average hospitalization day was longer（P=0.03）， the operation time and the intraoperative transfusion quantities（P=0.02， P=0.01） were larger in delirium group compared with which in non-delirium group， the differences were statically significant. The sodium ion and chloride ion postoperative 2 days and 3 days were lower， and the potassium ion postoperative 3 days was lower， the differences were statically significant（P 　　1 资料与方法 　　1.1 一般资料 　　回顾性选择2013年1月～2015年8月我科收治的70例高龄脊柱手术治疗后转入ICU监护治疗的患者。男32例，女38例；年龄60～86岁，平均年龄（70.1±5.8）岁；转入ICU时33例未拔出气管插管，37例已拔出。65例行多节段脊柱融合术，5例行前路颈椎间盘切除术。根据术后是否发生谵妄分为两组：谵妄组及非谵妄组。 　　1.2 纳入排除标准