某醫學中心骨科老人術後多面向照護預防譫妄之成效

Effectiveness of Preventing Delirium After Surgery for Older Adults in a Taiwanese Medical Center

10.6142/VGHN.202106_38(2).0001

林麗華(Li-Hwa Lin)；黃秀英(Hsiu-Ying Huang)；詹雅惠(Ya-Hui Tsan)；鄭慧娟(Hui-Chuan Cheng)

老人 ； 骨科手術 ； 多面向照護 ； 譫妄 ； older adults ； orthopedic surgery ； multifaceted care ； delirium

榮總護理

38卷2期（2021 / 06 / 01）

112 - 119

繁體中文

背景：譫妄在骨科老人術後發生率高，若未能早期發現及時處置，將出現併發症，延長住院天數，增加死亡率，影響病人安全。目前國內尚無預防譫妄發生率之相關文獻，因此本研究目的在探討骨科老人術後多面向照護介入措施以預防譫妄之成效。方法：採類實驗研究設計，以方便取樣方式收案196位骨科老年病人，對照組98位，實驗組98位；研究工具為簡易心智量表（Mini-Mental State Examination, MMSE）與混亂評估量表（Confusion Assessment Method, CAM）；兩組病人於入院當天評估MMSE與完成第一次評估CAM，之後每天評估CAM直到出院為止，對照組給予常規照護，實驗組給予多面向照護。結果：以SPSS 20.0進行統計分析，結果發現對照組譫妄發生率為3.6%，實驗組譫妄發生率為0%，實驗組相較於對照組的譫妄風險比為0.02，達到統計上顯著差異（p= .03）。結論：多面向照護介入措施可以有效預防骨科老人術後譫妄的發生，維持日常生活功能與生活品質，提供未來預防譫妄照護措施之參考。

Background: Delirium has a high incidence density in older patients who have received orthopedic surgery. If it is not detected early and treated in a timely manner, the patient's safety is compromised and they tend to be hospitalized for longer. No study has addressed the prevention of delirium incidence density in Taiwan. Therefore, the purpose of this study was to explore the effectiveness of multifaceted care in preventing delirium after surgery among older patients. Methods: A quasi-experimental research design was adopted. A total of 196 older patients who received orthopedic surgery were enrolled using convenience sampling; 196 patients were assigned to control and experimental groups at a 1:1 ratio. This study used the Mini Mental State Examination (MMSE) and the Confusion Assessment Method (CAM) as research tools. The two groups of patients were assessed using MMSE and CAM at the day of admission. CAM was then used to evaluate patients every day until discharge. The control group was given routine care, and the experimental group was given multifaceted care. Results: Statistical analysis was performed with SPSS 20.0. The incidence densities of delirium in the control and experimental groups were 3.6% and 0%, respectively. The risk ratio of delirium between the experimental and control groups was 0.02. These differences were statistically significant (p= .03). Conclusion: Multifaceted care can effectively prevent the occurrence of delirium in older adults following orthopedic surgery, helping them maintain their daily function and quality of life. The findings help clinicians better prevent delirium.

1. 王艷艷,廖玉麟,高浪麗,胡秀英,岳冀蓉(2017)。運用「住院老年患者生活項目」建構中文化「老年患者術後譫妄預防的多學科綜合處置模式。護理雜誌，64(3)，33-42。
   連結：
2. 楊鎮嘉,高玉娟(2017)。譫妄症臨床診治。長期照護雜誌，21(2)，81-92。
   連結：
3. Hshieh, T. T.,Yang, T.,Gartaganis, S. L.,Yue, J.,Inouye, S. K.(2018).Hospital elder life program: Systematic review and meta-analysis of effectiveness.The American Journal of Geriatric Psychiatry,26(10),1015-1033.
4. Inouye, S. K.,Westendorp, R. G.,Saczynski, J. S.(2014).Delirium in elderly people.The Lancet,383(9920),911-922.
5. Kratz, T.,Heinrich, M.,Schlauß, E.,Die fenbacher. A.(2015).Preventing postoperative delirium.Deutsches Ärzteblatt International,112(17),289-296.
6. Martinez, F.,Tobar, C.,Hill, N.(2015).Preventing delirium: Should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature.Age and Ageing,44(2),196-204.
7. McDaniel, M.,Brudney, C.(2012).Postoperative delirium: Etiology and management.Current Opinion in Critical Care,18(4),372-376.
8. Michaud, L.,Büla, C.,Berney, A.,Camus, V.,Voellinger, R.,Stiefel, F.,Burnand, B.(2007).Delirium: Guidelines for general hospitals.Journal of Psychosomatic Research,62(3),371-383.
9. Mitchell, A. J.,Shukla, D.,Ajumal, H. A.,Stubbs, B.,Tahir, T. A.(2014).The Mini-Mental State Examination as a diagnostic and screening test for delirium: Systematic review and meta-analysis.General Hospital Psychiatry,36(6),627-633.
10. Mouchoux, C.,Rippert, P.,Duclos, A.,Fassier, T.,Bonnefoy, M.,Comte, B.,Heitz, D,Colin, C.,Krolak-Salmon, P.(2011).Impact of a multifaceted program to prevent postoperative delirium in the elderly: The CONFUCIUS stepped wedge protocol.BioMed Central Geriatrics,11(25)
11. Oberai, T.,Laver, K.,Crotty, M.,Killington, M.,Jaarsma, R.(2018).Effectiveness o f multicomponent inte rvention s on incidence of delirium in hospitalized older patients with hip fracture: A systematic review.International Psychogeriatrics,30(4),481-492.
12. Yang, Y.,Zhao, X.,Dong, T.,Yang, Z.,Zhang, Q.,Zhang, Y.(2017).Risk factors for postoperative delirium following hip fracture repair in elderly patients: A systematic review and meta-analysis.Aging Clinical and Experimental Research,29(2),115-126.
13. 陳依鈴,孫守涓,黃采薇(2012)。外科加護病房病人譫妄發生率及相關因素探討。彰化護理，19(4)，33-40。
14. 楊鎮嘉,溫瓊容,詹鼎正(2014)。老人譫妄症。內科學誌，25(3)，143-150。
15. 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。
16. 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. 鄭易姍,葉雅惠,張綺芸(2023)。運用情境模擬影片教學提升護理人員之譫妄知識與評估能力。榮總護理，40(3)，281-292。