危重症患者身体约束使用现状及影响因素分析

Analysis on current situation and influencing factors of physical restraint in critically ill patients

目的调查重症监护室患者身体约束的实施情况,并分析其影响因素。方法收集我院2019年6—12月入住重症监护室的238例患者为研究对象,根据治疗护理需求,分为约束组(106例)和未约束组(132例),通过国内外文献回顾、小组讨论等方法,设计身体约束调查表,分析身体约束相关因素,如年龄、性别、APACHEⅡ评分、ICU住院时间、意识状态、身体约束原因、机械通气、镇静、镇痛、谵妄、鼻胃管、导尿管、中心静脉导管以及侵入性操作治疗种类使用情况,对两组之间可能发生的危险因素采用统计学方法处理。结果238例患者中,106例予以身体约束,身体约束率为44.5%。根据Logistic回归分析,机械通气、谵妄、侵入性操作治疗种类3种以上及镇静药物、中度意识障碍在多因素回归分析中,差异有统计学意义(P<0.05)。结论机械通气、谵妄、侵入性操作治疗种类及镇静药为重症监护室患者身体约束的独立危险因素。应根据我国实际情况制定重症监护室患者身体约束使用规范及标准,加强对相关人员的培训,指导临床对身体约束的合理使用。

Objective To investigate the implementation of physical restraint in intensive care unit and analyze its influencing factors.Methods A total of 238 patients who were admitted to the intensive care unit in our hospital from June 2019 to December 2019 were collected as the study subjects.According to the needs of treatment and nursing,the patients were divided into the restrained group(106 cases)and the unrestrained group(132 cases).A physical restraint questionnaire was designed through domestic and foreign literature review,group discussion and other methods.Factors related to physical restraint were analyzed,such as age,gender,APACHEⅡscore,length of stay in ICU,state of consciousness,reasons for physical restraint,mechanical ventilation,sedation,analgesia,delirium,nasogastric tube,urinary catheter,central venous catheter,and types and usage of invasive procedures.The possible risk factors between the two groups were statistically analyzed.Results 106 of the 238 patients were physically restrained,and the physical restraint rate was 44.5%.According to Logistic regression analysis,the differences in the mechanical ventilation,delirium,more than three types of invasive procedures,sedative drugs,and moderate consciousness disturbance were statistically significant in the multivariate regression analysis(P<0.05).Conclusion Mechanical ventilation,delirium,types of invasive procedures and sedative drugs are independent risk factors for physical restraint in the patients admitted in the intensive care unit.The norms and standards for the use of physical restraints for patients in the intensive care unit should be formulated according to the actual situation in China,and the training of relevant personnel should be strengthened to guide the rational use of physical restraints in clinical settings.