冠状动脉搭桥术后谵妄患者的循证治疗

摘要

Objective To formulate an evidence-based treatment plan for the patients with delirium after off-pump coronary artery bypass surgery.Methods Based on an adequate review of patients'conditions, the databases of Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP Database and WanFang Database were retrieved after translating clinical problems to available to retrieving.Results There were totally 4 postoperative Meta-analyses on delirium assessment tools, risk factors (anesthesia ways, hypertension, diabetes, and arrhythmia) and administration of sedative drugs, 1 systematic review (SR), 2 randomized controlled trials (RCT) and 1 review were collected. According to retrieving results and patients' conditions and preference, an effective treatment plan was formulated as follows: the patients were dynamically and objectively reviewed by using confusion assessment method for the intensive care unit (CAM-ICU), treated with naloxone combining olanzapine, and original diseases were actively treated and controlled including hypertension, diabetes and arrhythmia.Conclusion The comprehensive treatment plan is formulated by applying evidence-base review for promoting the curative effect and cure in patients with delirium after off-pump coronary artery bypass surgery.%目的 为非体外循环下冠状动脉搭桥术后谵妄患者制定合理的循证治疗方案.方法 在充分评估患者病情基础上,提出临床问题并转换成便于检索的形式,检索Cochrane Library,PubMed,EMbase,CBM,CNKI,VIP和WanFang数据库.结果 共检索出有关术后谵妄评估工具、谵妄风险(麻醉方式、高血压、糖尿病、心律失常)、镇静药物的使用相关的Meta分析4篇,系统评价(systematic review,SR)1篇,随机对照试验(randomized controlled trials,RCT)2篇,综述1篇.根据检索结果 ,并结合患者病情和意愿,制定出有效的谵妄治疗方案:采用重症监护室意识模糊评估法(confusion assessment method for the intensive care unit,CAM-ICU)工具对患者进行动态、客观的评估,采用纳洛酮联合奥氮平药物治疗,积极治疗和控制高血压、糖尿病、心律失常的原发病变.结论 采用循证证据评价为冠状动脉搭桥术后谵妄患者制定全面的治疗方案来促进谵妄的治疗及愈合.