| 谵妄早期评估及干预对急诊重症患者临床结局的影响 |
| Alternative Title | The influence of early assessment and intervention for delirium on the outcome of the patients of emergency intensive care unit
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| 唐勇 |
| Thesis Advisor | 马莉
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| 2015-05-20
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| Degree Grantor | 兰州大学
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| Place of Conferral | 兰州
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| Degree Name | 硕士
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| Keyword | 早期谵妄评估
28天病死率
住院时间
住院费用
机械通气时间
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| Abstract | 目的采用CAM-ICU评分表对入住兰州大学第二医院急诊ICU（EICU）的患者每日进行谵妄评估，研究谵妄早期评估及干预对急诊重症患者临床结局的影响。方法纳入2014年9月至2015年3月入住兰州大学第二医院危重病科的150例患者，使用随机数字表将患者随机分为实验组（CAM-ICU）与对照组。排除24h内转出ICU的患者，或者24h内死亡，或者预计不能苏醒者。CAM-ICU组每天上午9：00-11：00晚上8：00-10：00对入住患者进行谵妄评估，对照组患者仅在出现明显谵妄临床症状时采用CAM-ICU诊断谵妄，两组患者在入住急诊ICU后均给予相同的基础治疗。比较两组患者谵妄发生率及早期干预对两组患者机械通气时间、住院时间、住院费用、28天病死率的差异。结果1.兰州大学第二医院危重病科谵妄发病率为34.67%，与既往报道相似；2.与非谵妄患者相比，谵妄患者的ICU住院时间、机械通气时间更长，住院费用更多，28天病死率更高；3.与对照组相比，CAM-ICU组患者的住院时间、机械通气明显短与对照组，住院费用及28天病死率与对照组无统计学差异。结论本研究发现患者谵妄的发病率为34.67%；谵妄患者住院时间、机械通气时间更长，住院费用更多，28天病死率更高；每日进行谵妄评估并给予早期干预，可提高患者的谵妄诊断率，可降低患者住院时间，机械通气时间。 |
| Other Abstract | Objective
To determine the influence of early assessment and intervention for delirium on the outcome of the patients in emergency intensive care unit.
Methods
One hundred and fifty patients sequentially admitted in the emergency intensive care unit of the second hospital of Lanzhou university from September 2014 to March 2015 were enrolled this study with rules and regulations of the medical ethic committee on Research Human Care at the the second hospital of Lanzhou university.The patients were randomly divided into experimental group and control group by random number table.The patients who is transferred from EICU in 24h,or died within 24h,or expected to be unawakened (such as craniocerebral trauma,diffuse axonal injury, brain stem hemorrhage,large area cerebral infarction),and with the deaf history,dementia,psychosis,chronic mental retardation and other neurological diseases were also excluded.With the patients admission immediately in CAM-ICU group,CAM-ICU was used to assess the occurrence rate of delirium for patients admitted at 9:00 to 11:00 am and 8:00 to 10:00 pm,respectively.The patients in control group were assessed only in the presence of clinical obvious symptoms of delirium. Both groups in the emergency ICU were given the same support therapy, including actively treating the primary disease,controlling infection,maintaining water and electrolyte balance, nutritional support and other support therapy;minimizing limb braking and encouraging early activities;When delirium occurred,patients were immediately given interventions.Then to compare the occurence rate of deliriun,the mechanical ventilation time,the ICU length of hospital stay,hospitalization expenses and 28 days mortality between both groups.
Result
1.The incidence of critical patient delirium was 34.67% in the second hospital of lanzhou university,similar to previous reports.
2.Compared with patients without delirium, delirium patients had a longer length of hospital stay and mechanical ventilation time,the hospitalization costs was more, the 28 days mortality was higher(P<0.05).
3.Compared with the control group, the CAM - ICU patients had significantly shorter hospital stay and mechanical ventilation time(P<0.05),the hospitalization expenses and 28 days mortality compared with the control group had a downward trend, but had no statistical difference(P>0.05).
Conclusions
This study found that the incidence of delirium of the Emergency ICU is 34.67%... |
| URL | 查看原文
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| Language | 中文
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| Document Type | 学位论文
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| Identifier | https://ir.lzu.edu.cn/handle/262010/222253
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| Collection | 学院待认领
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| Affiliation | 临床医学院
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Recommended Citation
GB/T 7714 |
唐勇. 谵妄早期评估及干预对急诊重症患者临床结局的影响[D]. 兰州. 兰州大学,2015.
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