Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK.
Cotswold House, Oxford Health NHS Foundation Trust Adult Mental Health Services, Oxford, Oxfordshire, UK.
Evid Based Ment Health. 2019 May;22(2):77-82. doi: 10.1136/ebmental-2018-300064. Epub 2019 Apr 19.
Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.
卧床休息通常在医疗和儿科病房中使用，作为对患有严重神经性厌食症的身体虚弱患者进行护理管理的一部分。本研究旨在回顾卧床休息作为严重神经性厌食症管理干预措施的证据基础。我们使用以下术语在 2018 年 4 月之前在 MEDLINE、PubMed、Embase、PsychInfo、CINAHL、HMIC、AMED、HBE 和 BNI 以及英文编写的指南中搜索了床休息和神经性厌食症：卧床休息和神经性厌食症。排除重复项后，纳入了三项指南和八项文章。这些论文在方法学上存在异质性，因此无法进行定量总结。没有随机对照试验来比较卧床休息作为神经性厌食症治疗干预焦点的益处和危害。一些论文表明，患者强烈倾向于采用限制较少的方法。这些方法在护理时间上也不那么密集。一些研究描述了负面的身体后果：这些包括心率降低、骨周转率受损和感染风险增加。我们没有发现证据支持在医院治疗神经性厌食症时使用卧床休息。卧床休息相关的风险很大，包括身体和心理伤害，通过早期活动可以避免这些伤害。鉴于卧床休息在其他危重患者群体中已确定的并发症，很难建议对神经性厌食症患者实施卧床休息。未来的研究应侧重于安全的早期活动，这将减少并发症并提高患者满意度。
