일 종합병원 외과 중환자실 환자의 섬망 아형별 관련 요인
Factors Related to Motor Subtypes of Delirium Patients in a Surgical Intensive Care Unit
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목적: 본 연구의 목적은 외과중환자실 환자의 섬망 아형을 파악하고, 섬망 아형에 따른 대상자의 특성과 관련 요인을 파악하기 위함이다. 방법: 자료수집은 일 대학병원 외과중환자실에서 2018년 10월부터 2019년 6월까지 시행하였다. 섬망은 CAM-ICU로, 섬망 아형은 DMSS-4로 측정하였다. 대상자 특성은 전자의무기록을 통해 수집하였고, 데이터 분석은 기술통계를 사용하였다. 결과: 연구기간 입실한 총 1,112명 가운데 섬망 환자는 172명이었다(15.5%). 치매 환자와 연구 참여를 거부한 환자를 제외하고, 126명의 대상자가 최종 분석에 포함되었다. 섬망 아형은 과활동성 32.5%, 저활동성 42.9%, 혼합성 11.9%, 아형 없음 섬망이 12.7%이었다. 결론: 본 연구 결과 외과중환자실에서 저활동성 섬망이 가장 많았고, 인공호흡기 적용, 진정제 투여, 카테터 보유 개수도 저활동성 섬망 환자가 과활동성 섬망 환자보다 많았으며 간호중증도도 더 높았다. 그러므로, 구조화된 도구를 사용하여 조기에 섬망 아형을 사정하고, 각 아형에 적합한 간호 중재를 개발하는 것이 필요하다.
Abstract
Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in * city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients’ characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.
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