重症病人譫妄ABCDEF組合式照護與應用

譫妄是一種急性出現的認知混亂症狀，常見於重症單位病人，當病人入住重症單位時，醫護人員往往將疾病照護及穩定生命徵象視為首要目標，導致譫妄症狀在臨床上不易被診斷或發現。譫妄會影響病人意識及定向感紊亂、注意力差及認知功能損傷，使得呼吸器使用以及住院時間延長，甚至增加死亡率及再入院機率。回顧ABCDEF譫妄組合式照護（A疼痛評估、B呼吸、C協調照護整合、D譫妄評估、E早期活動、F家屬參與）相關文獻，發現介入措施複雜且繁瑣，容易讓人感到混淆，進而造成運用上的困難，藉由文獻回顧及統合分析方式驗證其有效性，期望經由相關實證文獻統整，為臨床照護人員提供完整的評估、有效的處置與應用。

關鍵字

重症病人；譫妄； ABCDEF組合式照護

並列摘要

Delirium is an acute symptom of cognitive disturbance and is common in patients in critical care units. For patients admitted to such units, delaying disease progression and stabilizing vital signs are the primary goals; delirium symptoms are difficult to diagnose and detect clinically. Delirium can lead to disturbed consciousness and orientation, poor attention, and cognitive impairment, which in turn can prolong the use of a ventilator and the length of hospital stay and even increase the likelihood of mortality and readmission. A review of the relevant literature on the ABCDEF bundle for delirium care (A: pain assessment, B: breathing, C: coordinated care integration, D: delirium assessment, E: early activities, F: family participation) revealed that this intervention's measures are inconsistent and that nurses are unfamiliar with the intervention. Because of difficulties with application of the ABCDEF bundle, its effectiveness was verified through a literature review and integrated analysis. Integrating the relevant empirical literature may provide nurses with comprehensive insights into the effective treatments and bundles for patients with severe delirium.