ICU患者早期康复方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2020.01.001

摘要/Abstract

摘要：

目的构建并应用ICU患者早期康复方案,以降低ICU获得性衰弱（intensive care unit acquired weakness,ICU-AW）的发生率,改善ICU患者的临床结局。方法运用文献分析法和Delphi法构建ICU患者早期康复方案,将70例于2018年10月—2019年4月入住安徽省某三级甲等医院综合ICU的患者随机分为试验组和对照组,每组各35例,试验组按本研究制订的方案进行康复,对照组按ICU护理常规进行康复,干预后采用英国医学研究委员会（Medical Research Council,MRC）肌力评定法、Barthel指数评定表、ICU-AW的发生率、ICU住院时间评估两组的干预效果。结果本研究构建的ICU患者早期康复方案包括早期运动、心理护理、营养支持、效果评价4个部分,32项具体康复内容。试验组转出ICU当天的肌力、Barthel指数评分均显著高于对照组（P<0.001）,ICU住院时间短于对照组（P<0.05）,ICU-AW的发生率显著低于对照组（P<0.05）。结论本研究构建的ICU患者早期康复方案具有较强的科学性和可靠性,应用该方案能降低ICU-AW的发生率,改善患者的临床护理结局。

关键词: 德尔菲技术, 危重症, ICU获得性衰弱, 康复护理

Abstract:

Objective To construct and implement the early rehabilitation scheme for prevention of Intensive Care Unit acquired weakness（ICU-AW） in order to reduce the incidence of ICU-AW and improve clinical nursing outcomes of ICU patients. Methods Literature analysis and Delphi method were applied to construct the early rehabilitation scheme for prevention of ICU-AW. 70 patients admitted in one comprehensive ICU at a tertiary hospital in Anhui Province from October 2018 to April 2019 were randomly divided into an experimental group and a control group （35 patients in each group）. The control group was given routine rehabilitation nursing in ICU,while the experimental group was given the early rehabilitation scheme developed in this study. After intervention,Medical Research Council（MRC） muscle strength assessment,Barthel index evaluation form,the incidence of ICU-AW and the length of ICU stay were used to evaluate the effects of intervention. Results The constructed scheme contained four parts,including early exercise,psychological nursing,nutrition support and effect evaluation,and 32 specific rehabilitation contents. In this study,the muscle strength and Barthel index score of the experimental group were significantly higher than those in the control group（P<0.001） on the day of ICU discharge;the length of ICU stay was shorter in the experimental group（P<0.05）;the incidence of ICU-AW was significantly lower than that in the control group（P<0.05）. Conclusion The constructed early rehabilitation scheme for the prevention of ICU-AW is scientific and reliable. The implementation of the scheme can decrease the incidence of ICU-AW and improve the clinical nursing outcomes of patients.

Key words: Delphi Technique, Critical Illness, Intensive Care Unit Acquired Weakness, Rehabilitation Nursing

韩汝宁, 李秀川, 赵士兵, 李亚军, 陈莲芳, 段缓, 杨婷婷. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志, 2020, 55(1): 8-15.

HAN Runing, LI Xiuchuan, ZHAO Shibing, LI Yajun, CHEN Lianfang, DUAN Huan, YANG Tingting. Construction and application of early rehabilitation scheme for Intensive Care Unit patients[J]. Chinese Journal of Nursing, 2020, 55(1): 8-15.

图/表 5

表1 2轮专家函询的肯德尔和谐系数及显著性检验结果

表2 ICU患者早期康复方案

续表2 ICU患者早期康复方案

表3 两组一般资料比较

表4 两组肌力、Barthel指数、ICU住院时间、ICU获得性衰弱发生率比较

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