论文部分内容阅读
目的:构建老年骨科创伤患者围手术期谵妄防控体系，评估其临床应用价值。方法:参照奥马哈系统管理框架和内涵，查阅相关文献，结合患者人口学信息、病情特征、临床治疗等明确谵妄发生的风险点，制订老年骨科创伤患者围手术期谵妄防控方案及符合实际使用要求的谵妄防控交接单。采用便利抽样法选取2019年10月—2020年10月海军军医大学第一附属长海医院收治的120例行手术治疗并进行围手术期谵妄护理防控的老年骨科创伤患者作为试验组，选取2018年5月—2019年5月长海医院收治的111例行手术治疗并行常规护理的老年骨科创伤患者作为对照组。比较围手术期谵妄防控方案实施前后患者的谵妄发生情况。结果:试验组患者经谵妄防控干预后至术前1 d时的谵妄风险评分较入院时下降，差异有统计学意义（n P<0.05）；术后3 d内的谵妄风险虽有提高，但经谵妄防控干预后至术后7 d时的谵妄风险评分较术后3 d时下降，差异有统计学意义（n P<0.05）。住院期间，试验组患者谵妄发生率为14.2%（17/120），低于对照组的24.3%（27/111），差异有统计学意义（n P<0.05）。n 结论:基于奥马哈系统理论构建的围手术期谵妄防控方案可以降低老年骨科创伤患者的谵妄风险。“,”Objective:To establish a prevention and control system for perioperative delirium in elderly patients with orthopedic trauma and evaluate its clinical application value.Methods:By referring to the Omaha system management framework and connotation, reviewing relevant literature and combining with demographic information, disease characteristics and clinical treatment of patients, the risk points of delirium occurrence were defined. A perioperative delirium prevention and control plan for elderly orthopedic trauma patients and a delirium prevention and control transfer order that met the actual use requirements were developed. The convenient sampling method was used to select 120 elderly patients with orthopedic trauma who were admitted to the First Affiliated Changhai Hospital of Naval Military Medical University from October 2019 to October 2020 who underwent surgical treatment and perioperative delirium care prevention and control as the experimental group. A total of 111 elderly patients with orthopedic trauma who received surgical treatment and routine care from May 2018 to May 2019 were selected as the control group. The incidence of delirium in patients before and after the implementation of the perioperative delirium prevention and control scheme was compared.Results:The delirium risk score of the patients in the experimental group after the intervention of delirium prevention and control to 1 day before surgery was lower than that at admission, and the difference was statistically significant (n P<0.05) . Although the risk of delirium increased within 3 days after operation, the delirium risk score after intervention for prevention and control of delirium to 7 days after operation was lower than that at 3 days after operation, and the difference was statistically significant (n P<0.05) . During the hospitalization period, the rate of delirium in the experimental group was 14.2% (17/120) , lower than 24.3% (27/111) in the control group, and the difference was statistically significant (n P<0.05) .n Conclusions:The prevention and control scheme for perioperative delirium based on the Omaha system theory can reduce the risk of delirium in elderly patients with orthopedic trauma.