重症譫妄預測模型於加護病房之應用

Application of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) Delirium Prediction Model

10.6142/VGHN.201909_36(3).0001

何牧行(Mu-Hsing Ho)；潘潔馨(Chieh-Hsin Pan)；葉昌振(Chang-Jenn Yeh)；黎書亮(Kevin Shu Leung Lai)；蕭淑代(Shu-Tai Shen Hsiao)

重症譫妄預測模型 ； 重症照護 ； 加護病房 ； 譫妄 ； PRE-DELIRIC ； critical care ； intensive care unit ； delirium

榮總護理

36卷3期（2019 / 09 / 01）

222 - 228

繁體中文

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.

1. Lou, M. F.,Dai, Y. T.(2002).Nurses' experience of caring for delirious patients.The Journal of Nursing Research,10(4),279- 290.
   連結：
2. Azuma, K.,Mishima, S.,Shimoyama, K.,Ishii, Y.,Ueda, Y.,Sakurai, M.,Oda, J.(2018).Validation of the prediction of delirium for intensive care model to predict subsyndromal delirium.Acute Medicine & Surgery
3. Bergeron, N.,Dubois, M. J.,Dumont, M.,Dial, S.,Skrobik, Y.(2001).Intensive care delirium screening checklist: Evaluation of a new screening tool.Intensive Care Medicine,27(5),859-864.
4. Boettger, S.,Garcia Nunez, D.,Meyer, R.,Richter, A.,Rudiger, A.,Schubert, M.,Jenewein, J.(2018).Screening for delirium with the intensive care delirium screening checklist (ICDSC): A re-evaluation of the threshold for delirium.Swiss Medical Weekly,148,w14597.
5. Ely, E. W.,Margolin, R.,Francis, J.,May, L.,Truman, B.,Dittus, R.,Inouye, S. K.(2001).Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care unit (CAM-ICU).Critical Care Medicine,29(7),1370-1379.
6. EVIDENCIO. (2018). Delirium (PRE-DELIRIC) prediction model for intensive care patients, version 2 (Recalibrated). Retrieved from https://www.evidencio.com/models/show/608
7. Heriot, N. R.,Levinson, M. R.,Mills, A. C.,Khine, T. T.,Gellie, A. L.,Sritharan, G.(2017).Diagnosing delirium in very elderly intensive care patients.Intensive and Critical Care Nursing,38,10-17.
8. Linkaite, G.,Riauka, M.,Buneviciute, I.,Vosylius, S.(2018).Evaluation of PREDELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit.Acta medica Lituanica,25(1),14-22.
9. Neto, A. S.,Nassar, A. P., Jr.,Cardoso, S. O.,Manetta, J. A.,Pereira, V. G.,Esposito, D. C.,Slooter, A. J.(2012).Delirium screening in critically ill patients: A systematic review and meta-analysis.Critical Care Medicine,40(6),1946-1951.
10. Sosa, F. A.,Roberti, J.,Franco, M. T.,Kleinert, M. M.,Patron, A. R.,Osatnik, J.(2018).Assessment of delirium using the PREDELIRIC model in an intensive care unit in Argentina.Revista Brasileira de Terapia Intensiva,30(1),50-56.
11. van den Boogaard, M.,Pickkers, P.,Slooter, A. J.,Kuiper, M. A.,Spronk, P. E.,van der Voort, P. H.,Schoonhoven, L.(2012).Development and validation of PREDELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: Observational multicentre study.British Medical Association,344,e420.
12. van den Boogaard, M.,Schoonhoven, L.,Maseda, E.,Plowright, C.,Jones, C.,Luetz, A.,Pickkers, P.(2014).Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): A multinational observational study.Intensive Care Medicine,40(3),361-369.
13. 劉建良、陳亮恭(2011)。老年譫妄症。台灣老年醫學暨老年學雜誌，6(1)，1-14。
14. 鄭鴻志、陳奇祥、陳欽明、周偉倪、黃惠美(2016)。台灣成人加護病房病人疼痛、躁動和譫妄臨床診療指引（Taiwan PAD）第四部份：臨床推行策略與品質管理。台灣急重症醫學雜誌，1，90-99。
15. 賴玟苑、王韵宜、田秀娟、蘇美蘭、林淑媛(2011)。譫妄實證照護之應用。護理雜誌，58(2)，75-80。

1. 楊星瑜(2020)。加護單位重症患者譫妄的生理病理機轉與評估。護理雜誌，67(3)，14-22。