Exploration on the improvement of delirium in critically ill mechanically ventilated patients through sedative and analgesic bundle nursing
镇静镇痛集束护理对危重症机械通气患者谵妄改善探讨

摘要

目的 探讨镇静镇痛集束护理在危重症机械通气患者中的应用效果，明确其对谵妄发生及预后的影响。方法 选取2024年2月4日至2025年2月4日期间收治的58例危重症机械通气患者作为研究对象，采用随机数字表法分为观察组与对照组，每组各29例。对照组实施常规镇静镇痛护理，观察组应用镇静镇痛集束护理干预。比较两组患者谵妄发生率、谵妄持续时间、谵妄严重程度评分及预后相关指标。结果 观察组谵妄发生率为24.14%，显著低于对照组的51.72%（χ²=5.498，P=0.019）；观察组谵妄持续时间为（2.31±0.85）d，短于对照组的（4.76±1.23）d（t=9.274，P=0.000）；观察组干预后CAM-ICU评分为（3.12±1.05）分，低于对照组的（5.89±1.36）分（t=8.743，P=0.000）；观察组机械通气时间、ICU住院时间分别为（6.89±2.15）d、（10.32±3.01）d，均短于对照组的（9.76±2.87）d、（14.58±3.67）d（t=4.682、5.317，均P=0.000），且不良事件发生率为10.34%，低于对照组的34.48%（χ²=5.983，P=0.014）。结论 镇静镇痛集束护理可显著降低危重症机械通气患者谵妄发生率，缩短谵妄持续时间，减轻谵妄严重程度，同时改善患者预后，值得临床推广应用。

Abstract

Objective To explore the application effect of sedation and analgesia bundle nursing in critically ill mechanically ventilated patients, and clarify its impact on delirium occurrence and prognosis.
Methods 58 critically ill mechanically ventilated patients admitted between February 4, 2024 and February 4, 2025 were selected as the study subjects. They were randomly divided into an observation group and a control group using a random number table method, with 29 cases in each group. The control group received routine sedation and analgesia nursing, while the observation group received sedation and analgesia bundle nursing intervention. Compare the incidence, duration, severity score, and prognostic indicators of delirium between two groups of patients.
Results The incidence of delirium in the observation group was 24.14%, significantly lower than the 51.72% in the control group (χ²=5.498, P=0.019); The duration of delirium in the observation group was (2.31±0.85) days, which was shorter than that in the control group (4.76±1.23) days (t=9.274, P=0.000); After intervention, the CAM-ICU score of the observation group was (3.12±1.05) points, which was lower than that of the control group (5.89±1.36) points (t=8.743, P=0.000); The mechanical ventilation time and ICU hospitalization time of the observation group were (6.89±2.15) days and (10.32±3.01) days, respectively, which were shorter than those of the control group (9.76±2.87) days and (14.58±3.67) days (t=4.682, 5.317, both P=0.000). The incidence of adverse events was 10.34%, which was lower than that of the control group (34.48%,χ²=5.983, P=0.014).
Conclusion   Sedation analgesia bundle nursing can significantly reduce the incidence of delirium in critically ill mechanically ventilated patients, shorten the duration of delirium, alleviate the severity of delirium, and improve patient prognosis. It is worthy of clinical promotion and application.