身体约束缩减策略在ICU有创机械通气患者中的应用研究

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。

Effects of physical restraint reduction strategies on the incidence of delirium in ICU patients with invasive mechanical ventilation

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.