体外循环下心脏手术患者术后谵妄管理的循证实践

doi:10.3761/j.issn.0254-1769.2024.03.007

摘要/Abstract

摘要：

目的将体外循环下心脏手术患者术后谵妄管理的最佳证据应用于临床，评价应用效果。方法筛选体外循环下心脏手术患者术后谵妄管理的最佳证据。以证据为基础制订实践方案，进行基线审查、分析障碍因素，于2022年5月—2023年4月在武汉市某三级甲等综合医院心脏大血管外科开展循证实践。比较证据应用前后护士对术后谵妄管理的知信行水平、术后谵妄与亚谵妄发生情况和审查指标执行率。结果共纳入27篇文献，遴选23条适合临床的最佳证据，构建27条审查指标。通过循证实践，护士对术后谵妄管理的知信行得分由（100.81±13.92）分提高至（105.51±10.35）分，知识、态度、行为各维度得分均提高（P<0.05）；24个审查指标的执行率高于基线审查水平（P<0.05）；术后谵妄发生率由43.5%降至34.7%，差异无统计学意义（P=0.120）；术后亚谵妄发生率由55.1%降至40.1%（P=0.010），术后谵妄和亚谵妄持续时间均下降，差异均具有统计学意义（P<0.05）。结论构建的循证实践方案可以降低亚谵妄的发生率，减少术后谵妄及亚谵妄的持续时间，并能够提高护士对术后谵妄管理的知信行水平。

关键词: 体外循环, 心血管外科, 术后谵妄, 循证护理学

Abstract:

Objective To evaluate effectiveness of evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass. Methods The best evidence was selected for the prevention and management of delirium after cardiac surgery under cardiopulmonary bypass. From May 2022 to April 2023，the evidence-based nursing practice was developed and applied into the Department of Cardiovascular and Macro-vascular Surgery of a tertiary A general hospital in Wuhan. The nurses’ knowledge，belief and practice of postoperative delirium，incidence of postoperative delirium and subdelirium syndrome，the implementation rate of examination indicators were compared before and after the application of evidence. Results A total of 27 articles were finally included. Based on this，23 pieces of the best evidence were selected，and 27 review indicators were constructed. Through evidence-based practice，the scores of nurses’ knowledge，belief and practice questionnaire were significantly increased from（100.81±13.92） to （105.51±10.35）（P<0.05）. The implementation rate of 24 indicators was significantly higher compared with baseline review（P<0.05）. The incidence of delirium decreased from 43.5% to 34.7%（P=0.120）. The incidence of postoperative subdelirium syndrome decreased from 55.1% to 40.1%（P=0.010）. The duration of postoperative delirium and sub delirium significantly decreased，respectively（P<0.05）. Conclusion Evidence-based practice can reduce the incidence of subdelirium syndrome，and it can reduce postoperative delirium and the duration of subdelirium syndrome. It can improve nurses’ knowledge and practice of postoperative delirium care.

Key words: Cardiopulmonary Bypass, Cardiovascular Surgery, Postoperative Delirium, Evidence-Based Nursing

吴前胜, 曾莹, 王兰, 王萧萧, 周雁荣. 体外循环下心脏手术患者术后谵妄管理的循证实践[J]. 中华护理杂志, 2024, 59(3): 292-299.

WU Qiansheng, ZENG Ying, WANG Lan, WANG Xiaoxiao, ZHOU Yanrong. Evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass[J]. Chinese Journal of Nursing, 2024, 59(3): 292-299.

图/表 4

表1 体外循环下心脏手术患者术后谵妄管理的证据内容、审查指标及审查方法

Table 1 Evidence contents，review criteria，and review methods for management of postoperative delirium after cardiac surgery with cardiopulmonary bypass

表2 倾向性评分匹配前、后纳入患者的一般特征

Table 2 General characteristics of patients before and after propensity score matching

表3 培训前后护士对术后谵妄管理知信行问卷得分的比较（分，$ \bar{x} \pm s$）

Table 3 Comparison of nurses’ postoperative delirium nursing KAP scores before and after training（分，$ \bar{x} \pm s$）

表4 基于倾向性评分匹配的循证实践前后术后谵妄和亚谵妄发生情况

Table 4 Incidence of postoperative delirium and subdelirium syndrome before and after implementation based on propensity score matching

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