身体约束缩减策略在ICU有创机械通气患者中的应用研究

doi:10.3761/j.issn.0254-1769.2022.19.008

摘要/Abstract

摘要：

目的评价身体约束缩减策略对改善ICU有创机械通气患者身体约束的效果。方法 2021年2月—2022年2月,选择ICU有创机械通气患者为研究对象,按随机数字表法分为试验组和对照组,试验组采用身体约束缩减策略,对照组采用常规身体约束方法,比较两组身体约束时间、非计划拔管率、谵妄发生率、有创机械通气时间和ICU住院时间等。结果 113例患者完成研究,试验组57例,对照组56例。试验组和对照组身体约束率、非计划拔管率和皮肤异常的比较,差异无统计学意义（P>0.05）。两组身体约束时间、谵妄发生率、有创机械通气时间和ICU住院时间的比较,差异有统计学意义（P<0.05）。试验组身体约束累积使用率低于对照组,差异有统计学意义（ χ²=18.491,P<0.001）。试验组有创机械通气累积使用率低于对照组,差异有统计学意义（ χ²=9.244,P=0.002）。结论身体约束缩减策略可减少ICU有创机械通气患者身体约束时间,减少谵妄发生率、有创机械通气时间和ICU住院时间。

关键词: 身体约束, 缩减策略, 机械通气, 谵妄, 重症病房, 护理

Abstract:

Objective To evaluate the effect of physical restraint reduction strategies on the improvement of restraint practice of Intensive Care Unit（ICU） patients with invasive mechanical ventilation. Methods Patients with invasive mechanical ventilation admitted to ICU of our hospital from February 2021 to February 2022 were enrolled and divided into a control group and a study group according to random number table method. The control group adopted the conventional physical restraint method,and the study group adopted the physical restraint reduction strategy. The duration of physical restraint,unplanned extubation rate,delirium incidence,duration of invasive mechanical ventilation and days in ICU were compared between the 2 groups. Results 113 patients with 78 males and 35 females were eventually enrolled in the study,including 57 patients in the study group and 56 patients in the control group. There were no significant differences in physical restraint rate,unplanned extubation rate and skin abnormality rate between the study group and the control group（P>0.05）. The duration of physical restraint,delirium rate,duration of invasive mechanical ventilation and days in ICU in the control group were higher than those in the study group. The cumulative use rate of physical restraint was significantly different between the 2 groups（Log Rank test χ²=18.491,P<0.001）. The cumulative utilization rate of invasive mechanical ventilation was significantly different between the 2 groups（Log Rank test χ²=9.244,P=0.002）. Conclusion The physical restraint reduction strategy could reduce the duration of physical restraint,the incidence of delirium,the duration of invasive mechanical ventilation and the length of stay in ICU.

Key words: Physical Restraint, Reduction Strategy, Mechanical Ventilation, Delirium, Intensive Care Unit, Nursing Care

汪玫, 吴勇, 凌桂爱, 郑绍鹏. 身体约束缩减策略在ICU有创机械通气患者中的应用研究[J]. 中华护理杂志, 2022, 57(19): 2358-2362.

WANG Mei, WU Yong, LING Guiai, ZHENG Shaopeng. Effects of physical restraint reduction strategies on the incidence of delirium in ICU patients with invasive mechanical ventilation[J]. Chinese Journal of Nursing, 2022, 57(19): 2358-2362.

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参考文献 16

[1]	肖青青, 宋小珍, 喻红, 等. 身体约束与ICU患者谵妄发生风险关系的Meta分析[J]. 中国护理管理, 2021, 21(6):892-897.
	Xiao QQ, Song XZ, Yu H, et al. Meta-analysis of the relationship between physical restraint and the risk of delirium in ICU patients[J]. Chin Nurs Manag, 2021, 21(6):892-897.
[2]	汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识[J]. 中华内科杂志, 2019, 58(2):108-118. PMID
	Tang B, Wang XT, Chen WJ, et al. Experts consensus on the management of delirium in critically ill patients[J]. Chin J Intern Med, 2019, 58(2):108-118. DOI PMID
[3]	李雪苹, 王磊, 张淮, 等. Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的构建与效果验证[J]. 中华护理杂志, 2022, 57(8):950-957. DOI URL
	Li XP, Wang L, Zhang H, et al. Construction and evaluation of a risk prediction model of postoperative delirium in patients with Stanford type A aortic dissection[J]. Chin J Nurs, 2022, 57(8):950-957. DOI URL
[4]	陈国庆, 徐娟, 宋秀银, 等. ICU谵妄危险因素及集束化干预预防措施[J]. 国际护理学杂志, 2021, 40(15):2716-2719.
	Chen GQ, Xu J, Song XY, et al. Risk factors of delirium in ICU and cluster intervention and prevention measures[J]. Int J Nurs, 2021, 40(15):2716-2719.
[5]	Li X, Zhang LN, Gong F, et al. Incidence and risk factors for delirium in older patients following intensive care unit admission:a prospective observational study[J]. J Nurs Res, 2020, 28(4):e101-103.
[6]	van den Boogaard M, Peters SA, van der Hoeven JG, et al. The impact of delirium on the prediction of in-hospital mortality in intensive care patients[J]. Crit Care, 2010, 14(4):R146-148. DOI URL
[7]	Rajeev A, Railton C, Devalia K. The crucial factors influencing the development and outcomes of postoperative delirium in proximal femur fractures[J]. Aging Med (Milton), 2022, 5(2):94-100. DOI PMID
[8]	纪媛媛, 王军, 俞洁, 等. 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. DOI URL
	Ji YY, Wang J, Yu J, et al. Construction and application of a hierarchical management scheme of physical restraint for ICU patients in neurosurgery[J]. Chin J Nurs, 2021, 56(3):342-346. DOI URL
[9]	吴侠, 吴晓蓉, 徐爱花, 等. 基于德尔菲法构建的身体约束评估量表在住院患者身体约束缩减行动中的应用研究[J]. 中外医学研究, 2019, 17(24):117-119.
	Wu X, Wu XR, Xu AH, et al. Application of body restraint assessment scale based on Delphi method in body restraint reduction in hospitalized patients[J]. Chin Foreign Med Res, 2019, 17(24):117-119.
[10]	Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation:the eCASH concept[J]. Intensive Care Med, 2016, 42(6):962-971. DOI URL
[11]	中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南[J]. 中华危重病急救医学, 2018, 30(6):497-514. PMID
	Society of Critical Care Medicine,Chinese Medical Association. Guidelines for analgesia and sedation treatment in intensive care unit of Chinese adults[J]. Chin Crit Care Med, 2018, 30(6):497-514. DOI PMID
[12]	李玉冰, 胡英莉, 魏长云, 等. 身体约束缩减策略在危重症患者临床应用的效果研究[J]. 中华现代护理杂志, 2019, 25(32):4146-4151.
	Li YB, Hu YL, Wei CY, et al. Clinical application of body restraint reduction strategy in critically ill patient[J]. Chin J Mod Nurs, 2019, 25(32):4146-4151.
[13]	雷若冰, 蒋小平, 林楠, 等. ICU患者身体约束替代措施的证据总结[J]. 护理学杂志, 2019, 34(14):101-104.
	Lei RB, Jiang XP, Lin N, et al. Evidence summary:alternatives to physical restraint in ICU[J]. J Nurs Sci, 2019, 34(14):101-104.
[14]	刘丹, 吕杰, 安友仲. 机械通气老年危重症患者谵妄及预后的危险因素分析[J]. 中华危重病急救医学, 2016, 28(11):1003-1008.
	Liu D, Lü J, An YZ. Risk factors of delirium and outcomes in senile critical patients undergoing mechanical ventilation[J]. Chin Crit Care Med, 2016, 28(11):1003-1008.
[15]	李小珍, 邓伟, 徐琳, 等. ICU患者谵妄评估约束分级方案的构建及应用[J]. 中华护理杂志, 2019, 54(2):217-223. DOI URL
	Li XZ, Deng W, Xu L, et al. Construction and preliminary application of restraint grading program based on evaluation of delirium in ICU patients[J]. Chin J Nurs, 2019, 54(2):217-223. DOI URL
[16]	徐燕, 石卫琳, 郎黎薇, 等. 减少ICU患者身体约束的循证护理实践[J]. 中华护理杂志, 2019, 54(1):19-24.
	Xu Y, Shi WL, Lang LW, et al. Evidence-based nursing practice and evaluation of effects for reducing physical restraint among patients in ICUs[J]. Chin J Nurs, 2019, 54(1):19-24.