阮瑜 何政国

【摘要】 目的：探討老年肿瘤患者全麻术后苏醒期间谵妄的护理方法及效果。方法：选择笔者所在医院2017年1月-2018年10月收治的全麻术后苏醒期间谵妄的老年肿瘤患者60例，根据患者采用护理方法的不同将其分为30例观察组和30例对照组，观察组采用强化护理措施开展护理工作，对照组采用常规护理，比较两组老年患者全面复苏期间认知功能评价、术后谵妄情况及患者的护理满意度。结果：两组患者术后苏醒期间认知功能评分分别为（25.8±3.8）分与（21.4±2.1）分，观察组患者更高（P<0.05）。两组患者术后苏醒期间谵妄评分分别为（15.6±2.3）分及（22.4±4.1）分，对照组患者更高（P<0.05）。在护理满意度方面，观察组患者非常满意16例，满意11例，不满意3例，满意度为90.0%，比对照组患者的76.7%的满意度更高（P<0.05）。结论：针对老年肿瘤患者全麻术后苏醒期间出现的谵妄症状要严密观察，积极采用强化护理措施加强护理效果，才能缓解患者症状，保障治疗效果，提高护理满意度，促进患者的恢复。

【关键词】 老年肿瘤患者 全麻术 苏醒期间 谵妄 整体护理

doi：10.14033/j.cnki.cfmr.2019.30.055 文献标识码 B 文章编号 1674-6805（2019）30-0-03

[Abstract] Objective： To explore the nursing methods and effects of delirium in elderly cancer patients during recovery after general anesthesia.Method： Sixty elderly cancer patients with delirium during recovery from general anesthesia in our hospital from January 2017 to October 2018 were selected. They were divided into 30 cases observation groups and 30 cases control groups according to different nursing methods. The observation group adopted intensive nursing measures to carry out nursing work， while the control group adopted routine nursing. The cognitive function evaluation of the two groups during comprehensive recovery，postoperative delirium and patients satisfaction with nursing care were compared. Result： The cognitive function scores of the patients in the observation group and the control group during recovery were （25.8±3.8） points and （21.4±2.1） points respectively， the observation group was higher than that in the control group （P<0.05）. The delirium scores of the two groups during the recovery period were （15.6±2.3） points and （22.4±4.1） points respectively， the control group was higher than that in the control group （P<0.05）.In terms of nursing satisfaction， the patients in the observation group were very satisfied with 16 cases， satisfied with 11 cases， unsatisfied with 3 cases， and the satisfaction rate was 90%. The satisfaction rate of the observation group was higher than 76.7% of the control group （P<0.05）. Conclusion： In view of delirium symptoms in elderly cancer patients during recovery after general anesthesia， strict observation should be made and intensive nursing measures should be actively adopted to strengthen the nursing effect so as to alleviate the symptoms of patients， ensure the therapeutic effect， improve nursing satisfaction and promote the recovery of patients.

[Key words] Elderly patients with tumors General anesthesia operation Revival period Delirium Holistic nursing care

First-authors address： The First Affiliated Hospital of Xiamen University， Xiamen 361003， China

苏醒期谵妄和术后谵妄是很多老年肿瘤患者术后出现的一种急性脑功能障碍，通常发生在患者术后24～72 h，病程有波动的性质，患者有注意力障碍、认知障碍及知觉障碍的表现，尤其是对老年患者的预后产生严重影响，还容易导致意外的发生，严重威胁患者的身体健康和生命安全。有临床资料显示，老年肿瘤患者全麻术后发生谵妄的概率超过50%，而死亡率也接近10%，因此，减少患者术后谵妄发生，保障患者生命安全成为临床护理重点[1-2]。有临床实践发现，谵妄引发的因素包括高龄、视力与听力障碍、精神病、神经疾病等，此外还与患者选择的临床麻醉方式相关，而有资料显示，全麻手术也是老年肿瘤患者谵妄发生的独立高危因素[3]。针对老年肿瘤患者积极采取有效的护理方式，才能避免谵妄的情况发生，提高疗效。……