ICU患者早期活动分级实施路径的构建及初步验证

doi:10.3761/j.issn.0254-1769.2025.17.009

摘要/Abstract

摘要：

目的构建ICU患者早期活动分级实施路径，并初步验证其可行性和有效性。方法基于目标导向的早期活动理念，通过证据总结、德尔菲法，构建ICU患者早期活动分级实施路径，包含患者纳入、活动实施及活动评价3个部分。采用便利抽样法，选取2024年10月至2025年1月在北京市某三级甲等医院综合ICU符合标准的患者作为研究对象，其中2024年12月至2025年1月收治的25例患者为试验组，采用构建的ICU患者早期活动分级实施路径进行活动，2024年10—11月收治的25例患者为对照组，执行ICU常规活动。比较两组活动实施率、不良事件发生情况、膈肌移动度、肌力等指标的差异。结果 ICU患者早期活动分级实施路径的应用可使试验组活动实施率达到70.05%，高于对照组（P<0.001），且未增加不良事件的发生。试验组出ICU膈肌移动度高于对照组（P=0.018）。结论构建的ICU患者早期活动分级实施路径具有较好的科学性和实用性，可为ICU患者早期活动在临床广泛、有效开展提供参考，规范早期活动在ICU的落实。

关键词: 重症监护病房, 德尔菲技术, 早期活动, 康复护理, 呼吸锻炼, 肢体运动, 离床活动

Abstract:

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness. Methods Based on the “goal-directed” early mobility concept，a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method，consisting of 3 components：patient inclusion，mobility implementation，and mobility evaluation. Using convenience sampling，patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants. Among them，25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway. 25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care. Outcomes including diaphragm excursion，muscle strength，ICU length of stay，and adverse events were compared between the 2 groups. Results The graded early mobility pathway achieved an implementation rate of 70.05% in the experimental group，significantly higher than it in the control group（P<0.001），without increasing adverse events. Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group（P=0.018）. Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality. It provides a reference for the widespread and effective implementation of early mobility in ICUs，standardizing its clinical application.

Key words: Intensive Care Units, Delphi Technique, Early Mobility, Rehabilitation Nursing, Breathing Exercises, Limb Movements, Ambulation

李冰, 唐晟, 马燕兰, 慎玲玉, 赵庆华, 罗萍, 毕梦婕. ICU患者早期活动分级实施路径的构建及初步验证[J]. 中华护理杂志, 2025, 60(17): 2102-2109.

LI Bing, TANG Sheng, MA Yanlan, SHEN Lingyu, ZHAO Qinghua, LUO Ping, BI Mengjie. Construction and application of a graded early mobility path for critically ill adult patients[J]. Chinese Journal of Nursing, 2025, 60(17): 2102-2109.

图/表 3

表1 ICU患者早期活动分级实施路径

Table 1 Graded implementation path for early mobilization in critically ill patients

图1 重症患者早期活动分级实施路径示意图

Figure 1 Schematic diagram of graded implementation path for early mobility in critically ill patients

表2 两组有效性指标的比较[M（P25，P75）]

Table 2 Comparison of effectiveness indicators between the 2 groups[M（P25，P75）]

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