神经外科ICU患者身体约束分级管理方案的构建及应用

doi:10.3761/j.issn.0254-1769.2021.03.004

摘要/Abstract

摘要：

目的构建神经外科ICU患者身体约束分级管理方案并探讨其应用效果。方法组建研究团队并进行文献检索及相关问题讨论,制订神经外科ICU患者身体约束分级管理方案。采用便利抽样法,选择2019年4月—9月北京市某三级甲等医院神经外科ICU收治的患者304例,按入院时间将其分为试验组156例和对照组148例。试验组采用身体约束分级管理方案,对照组采用科室常规身体约束护理措施。比较两组身体约束率、平均约束时间、约束强度、谵妄发生率、非计划性拔管率、约束部位皮肤异常发生率的差异。结果干预后,试验组身体约束率、平均约束时间、约束强度、谵妄发生率均低于对照组（P<0.05）;两组均未发生非计划性拔管及约束部位皮肤异常。结论神经外科ICU患者身体约束分级管理方案可明显降低患者身体约束率、缩短约束时间、减少约束强度及谵妄的发生率,可为规范神经外科ICU患者身体约束的使用提供依据。

关键词: 重症监护病房, 神经外科, 身体约束, 分级管理, 护理

Abstract:

Objective To construct a hierarchical management scheme for physical restraint in the neurosurgery ICU patients and discuss its application effect. Methods Through the establishment of a project team,literature search and related issues discussion,a hierarchical management scheme for physical restraint in the neurosurgery ICU patients was developed. Using the convenience sampling method,304 patients admitted to the neurosurgery ICU of a tertiary first-class hospital in Beijing from April to September 2019 were selected,and they were divided into an experimental group with 156 cases and a control group with 148 cases according to admission time.The experimental group adopts a physical restraint hierarchical management plan,and the control group adopts the department's routine physical restraint nursing measures. The body restraint rate,average restraint time,restraint intensity,incidence of delirium,unplanned extubation,and the incidence of skin abnormalities at the restraint were compared between the 2 groups. Results After the intervention,the physical restraint rate,average restraint time,restraint intensity,and incidence of delirium in the experimental group were lower than those in the control group（P<0.05）;there were no unplanned extubation and skin abnormalities and other restraint-related complications in the 2 groups. Conclusion The graded management scheme for physical restraint in the neurosurgery ICU patients can significantly reduce the rate of physical restraint,shorten restraint time,reduce restraint intensity,and reduce the incidence of delirium,providing a basis for standardizing the use of physical restraint for neurosurgery ICU patients.

Key words: Intensive Care Units, Neurosurgery, Physical Restraints, Hierarchical Management, Nursing Care

纪媛媛, 王军, 俞洁, 欧梦仙, 赵朋朋, 李艳菲. 神经外科ICU患者身体约束分级管理方案的构建及应用[J]. 中华护理杂志, 2021, 56(3): 342-346.

JI Yuanyuan, WANG Jun, YU Jie, OU Mengxian, ZHAO Pengpeng, LI Yanfei. Construction and application of a hierarchical management scheme of physical restraint for ICU patients in neurosurgery[J]. Chinese Journal of Nursing, 2021, 56(3): 342-346.

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