摘要:
目的 探讨PAD集束干预策略对预防机械通气患者谵妄的效果.方法 选择2015年1月至2018年2月入住ICU经口气管插管机械通气患者243例,采用随机数字表法分为对照组(120例)和试验组(123例).对照组采用常规护理;试验组在常规护理的基础上采用PAD集束干预策略.对2组的镇静镇痛药物使用剂量、Richards Campbell睡眠量表(RCSQ)评分、谵妄发生率、谵妄持续时间、机械通气时间、ICU住院时间、28 d ICU病死率进行统计学分析.结果 试验组谵妄发生率、谵妄持续时间、机械通气时间、ICU住院时间分别为23.58%(29/123)、(2.83±1.20)d、(153.07±55.61)d、(7.88±2.89)d,对照组分别为40.00%(48/120)、(4.02±1.99)d、(170.90±63.51)d、(10.13±3.41)d,差异有统计学意义(χ2=8.298,Z=2.840、2.276、5.325,均P0.05).结论 将PAD集束干预策略应用于机械通气患者能降低谵妄发生率,缩短谵妄持续时间并且改善患者预后.%Objective To evaluate the effect of PAD bundle in mechanically ventilated patients for preventing delirium. Methods Two hundred and forty three patients with mechanical ventilation who were admitted in ICU from January 2015 to February 2018 were divided into two groups according to the method of random number table. The patients in the control group(120 cases) received routine nursing care. The patients in the experimental group(123 cases) received the PAD bundle on the basis of routine nursing care. The scores of Richards Campbell Sleep Questionnaire(RCSQ), the doses of sedatives and analgesics, incidence of delirium, duration of delirium, ventilator time, ICU length of stay and the 28-day ICU mortality were compared between the two groups. Results The incidence of delirium, duration of delirium, ventilator time, ICU length of stay was 23.58%(29/123), (2.83±1.20) d, (153.07±55.61) d, (7.88± 2.89) d in the experimental group, 40.00%(48/120), (4.02 ± 1.99) d, (170.90 ± 63.51) d, (10.13 ± 3.41) d in the control group, and there was significant difference between the two groups (χ2=8.298, Z=2.840, 2.276, 5.325, P 0.05). Conclusions The PAD bundle can decrease the incidence of delirium, the duration of delirium and improve prognosis of the patients with mechanical ventilation.