重症單位急性混亂患者之評估與護理

Assessment and Nursing Care of Patients in Acute Confusion in Intensive Care Units

本篇文章主要探討入住重症單位患者產生急性混亂的病因、影響因素、可供使用的評估工具及照護重點。筆者在臨床上常見重症患者因疾病快速變化導致腦部傳導神經物質發生變化，或在密閉照護空間中，缺乏外在環境刺激導致病人短時間有出現注意力及認知功能混亂情形；這些患者多半因無法配合治療，導致合併症發生，進而增加失能及死亡的機率，伴隨而來的是照護工作量的加重、住院天數延長以及增加醫院成本。而護理人員24小時守護病人，常是第一時間發現病人生理及心理變化的臨床工作者；但現今臨床實務工作卻缺乏一套快速、簡單及有效的評估工具可供重症護理人員早期診斷出病人的認知及注意力障礙，可早期給予醫療介入並提供有效的護理措施，降低各種合併症的發生。於是參考國內外相關研究報告，整理出臨床使用之相關量表，並列舉護理措施提供護理人員在臨床工作時的指引。

This article mainly discusses the causes of acute confusion and the factors affecting them among patients in intensive care units, while also identifying relevant assessment tools and important points for consideration in medical care. Clinically, it is often observed that patients in intensive care units (ICU) develop changes in the neurotransmitters of the brain that are due to rapid changes in their disease or to attention disorders or cognitive disorders resulting from lack of stimuli from the external environment in a closed space. These patients mostly fail to cooperate in their treatment, which leads to the occurrence of complications and further increases the probability of disability and death. Consequently, the workload of the ICU nurses becomes heavier, the patient's hospitalization is prolonged, and the hospital's costs increase. Usually nurses, who look after patients 24 hours a day, are the clinicians who first discover the patients' changes in physiology and psychology. In today's clinical practice, however, we lack an assessment tool which can help ICU nurses to diagnose early, and in a rapid, simple and effective way, the cognitive and attention disorders of patients in order to provide early medical interventions and effective nursing interventions and reduce the incidence of various complications. With reference to relevant domestic and foreign research reports, the author identifies some acute confusion assessment tools and relevant information on nursing interventions for the benefit of nurses, and as guidance in their clinical work.