神经外科ICU患者身体约束相关非计划拔管影响因素研究

Study on physical restraints practice and the interrelated factors on unplanned extubation of the patients in neurosurgical intensive care unit

目的 了解神经外科ICU患者身体约束使用特征,并分析影响非计划拔管的身体约束相关因素.方法 采用自行设计的身体约束与管路情况记录单,对106例使用身体约束的患者进行非计划拔管情况调查,并采用Logistic回归分析找出身体约束相关的非计划拔管的影响因素.结果 106例患者入住神经外科ICU期间身体约束162例次,以约束上肢为主（99例次）;身体约束时间2.5～677.0 （143.96±138.02） h;Logistic回归分析结果显示,约束执行时患者的意识状态、约束时间及部位是非计划拔管的预测因素（P＜0.05,P＜0.01）.结论 神经外科ICU患者身体约束使用时间较长,患者的意识状态、约束时长及约束部位是非计划拔管的影响因素.护士应正确判断约束时机、约束部位,提高约束的有效性,以降低非计划拔管.

Objective To study the characteristics of physical restraints on the patients in neurosurgical intensive care unit （NSICU）, and to analyze the factors related to physical restraints influencing unplanned extubation. Methods A total of 106 patients were investigated with questionnaire about physical restraints and unplanned extubation data. The factors related to physical restraints influencing unplanned extubation were found out through logistic regression analysis. Results The 106 patients during their stay in NSICU experienced physical restraints 162 times. The upper limbs were the most common sites used in physical restraints in 99 cases. The time length of physical restraints ranged from 2.5 h to 677.0 h, and the average was （143.96±138.02） h. The results of logistic regression analysis showed that three factors could affect unplanned extubation, including the state of consciousness during restraints, the time length and sites of restraints （P〈0.05, P〈0.01）. Conclusion The time length of physical restraints used on NSICU patients is long, and the patients＇ state of consciousness during restraints, the time length and sites of restraints are the factors influencing unplanned extubation. To improve the effectiveness of physical restraints and reduce the rate of unplanned extubation, nurses should correctly assess the timing and sites of constraints.