摘要
目的探讨基于舒适化浅镇静策略(eCASH)理念的身体约束缩减行动在ICU患者中的应用效果。方法采用随机对照试验设计,选取2024年1月—12月某三甲医院ICU患者196例,随机数字表法分为观察组(n=98)和对照组(n=98)。对照组采用常规身体约束管理;观察组实施基于eCASH理念的身体约束缩减行动,具体内容包括政策制度、约束决策、约束替代、约束实施。比较两组患者身体约束日数、约束率、舒适度、机械通气时间、入住ICU时间、非计划拔管率、ICU谵妄发生率、患者满意度。结果观察组约束日数(2.13±1.32)d,低于对照组(4.52±1.67)d(P<0.01);观察组身体约束率31.63%,低于对照组的58.16%(P<0.01);观察组舒适度评分(85.63±6.24)分,高于对照组的(72.35±7.81)分(P<0.01);观察组机械通气时间(48.72±12.35)h,低于对照组的(72.64±15.28)h(P<0.01);观察组入住ICU时间(5.26±1.83)d,低于对照组的(7.85±2.14)d(P<0.01);观察组非计划拔管率5.10%(5/98),低于对照组的7.14%(7/98),但差异无统计学差异(P>0.05);ICU谵妄发生率观察组低于对照组(12.24%vs.26.5%,P<0.01);患者满意度观察组高于对照组(90.82%vs.66.33%,P<0.01)。结论对ICU患者开展基于eCASH理念的身体约束缩减行动,能降低身体约束率,缩短患者约束时间,提高患者舒适度,降低患者谵妄发生率,缩短机械通气时间,减少ICU住院天数,提升患者满意度,具有临床推广价值。
Objective To evaluate the effectiveness of an early comfort using analgesia,min⁃imal sedatives and maximal humane care-based physical restraint reduction protocol in ICU pa⁃tients.Methods A randomized controlled trial was conducted involving 196 ICU patients from a tertiary hospital between January and December 2024.Participants were randomly assigned to ei⁃ther the observation group(n=98)or the control group(n=98)using a random number table.The control group received conventional physical restraint management,while the observation group implemented the eCASH-based restraint reduction protocal,which included:policy formulation,restraint decision-making,restraint alternatives,and restraint implementation.Outcomes com⁃pared between groups included restraint duration,restraint rate,comfort level,mechanical venti⁃lation duration,ICU length of stay,unplanned extubation rate,ICU delirium incidence,and patient satisfaction.Results The observation group demonstrated significantly fewer restraint days(2.13±1.32 d vs.4.52±1.67 d,P<0.01)and a lower physical restraint rate(31.63%vs.58.16%,P<0.01).Comfort scores were higher in the observation group(85.63±6.24 vs.72.35±7.81,P<0.01).The observation group also had shorter mechanical ventilation duration(48.72±12.35 h vs.72.64±15.28 h,P<0.01)and ICU length of stay(5.26±1.83 d vs.7.85±2.14 d,P<0.01).No significant difference was found in unplanned extubation rates(5.10%vs.7.14%,P>0.05).The observation group showed significantly lower ICU delirium inci⁃dence(12.24%vs.26.53%,P<0.01)and higher patient satisfaction(90.82%vs.66.33%,P<0.01).Conclusion Implementation of an eCASH-based physical restraint reduction initiative for ICU patients can significantly reduce physical restraint rates and duration,improve patient comfort,decrease delirium incidence,shorten mechanical ventilation time and ICU stay,and en⁃hance patient satisfaction,demonstrating substantial clinical value for widespread adoption.
作者
蔡聆静
蔡爱旎
蒋艳秋
陈丽调
洪涵涵
CAI Lingjing;CAI Aini;JIANG Yanqiu;CHEN Lidiao;HONG Hanhan(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Naval Medical University,Shanghai,200003;Department of Nursing,The Second Affiliated Hospital of Naval Medical University,Shanghai,200003)
出处
《中西医结合护理》
2025年第9期61-66,共6页
Chinese Journal of Integrative Nursing
基金
海军军医大学第二附属医院第十届护理科研基金(CZYY-HLZC1012)。
