重症譫妄預測模型於加護病房之應用

Abstract

譫妄的發生可能導致嚴重合併症使加護病房病人住院天數延長以及增加死亡率，且於臨床上難以被覺察與診斷；重症譫妄預測模型（PRE-DELIRIC）的發展協助臨床醫護人員能夠預測病人發生譫妄的風險，及早介入預防措施以避免譫妄發生，且過去研究已證實PRE-DELIRIC之預測力高於醫護人員主觀判斷。PRE-DELIRIC之演算項目包含年齡、APACHE II分數、尿液濃度、嗎啡使用劑量、鎮靜藥物使用、代謝性酸中毒、昏迷情形、緊急入院、入院科別及感染，建議各級醫院可將此模型建置於醫護資訊化系統中，擴大其效益並利於臨床重症照護專業人員運用及參考。本文介紹PRE-DELIRIC模型的發展與相關內容及探討其於加護病房之應用，並討論護理人員在預防譫妄上可執行之護理計畫與策略，期望提供重症照護護理人員在臨床照護上對於譫妄的早期監測、預防以及處理上有所助益。

Delirium leads to severe comorbidity and complications that can prolong hospital stays and increase mortality in critically ill patients; moreover, it is a difficult condition to detect and diagnose. The delirium prediction model (PREdiction of DELIRium in ICu patients; PRE-DELIRIC) has been developed to assist critical health care professionals to predict delirium, enabling them to prepare in advance interventions for preventing delirium in critically ill patients. The previous study indicated that the prediction accuracy of PRE-DELIRIC was higher than the subjective prediction value of healthcare professionals. The content of the formula for the PRE-DELIRIC model consists of age, APACHEII score, urea concentration, morphine doses, use of sedatives, metabolic acidosis, coma, urgent admission, admission category, and infection. We suggest that hospitals implementing the PRE-DELIRIC model into medical and nursing information systems should broaden the use of the PRE-DELIRIC model. This article introduces the development and application of the PRE-DELIRIC model in intensive care settings and further discusses nursing implementations for avoiding the incidence of delirium. It is expected that this article will provide information for the effective early detection, prevention, and management of delirium for critical care nurses.