Wu Yuchen, Jiang Biantong, Wang Guoqiang, Wei Huaping, Li Bin, Shen Xiping, Zhang Caiyun, Zhang Zhigang
Department of Intensive Care Unit, the First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China.
School of Nursing, Lanzhou University, Lanzhou 730000, Gansu, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Sep;32(9):1111-1117. doi: 10.3760/cma.j.cn121430-20200506-00358.
To investigate the current status of intensive care unit-acquired weakness (ICU-AW) assessment, analyze the assessment barriers, and to provide reference to improve ICU-AW assessment.
A convenient sampling cross-sectional survey was conducted. First, an interview outline which based on related domestic and international literatures and combining with the research purpose of this study were designed. Thirteen medical personnel (8 ICU nurses, 3 ICU doctors, 1 respiratory therapist and 1 physiotherapist) who worked in the intensive care unit (ICU) of the First Hospital of Lanzhou University were enrolled with convenience sampling method to interview. Second, the topics were comprehensively analyzed and extracted, and then a questionnaire was constructed, and the reliability and validity was assessed. Finally, the questionnaire survey including the general situation of ICU medical staffs, the current practices of ICU-AW and influencing factors was implemented in China.
The retest reliability was 0.92 and expert validity was 0.96 of the questionnaire. There were 3 563 respondents in 31 provinces, municipalities and autonomous regions which eliminated 357 unqualified questionnaires, including 173 respondents from neonatal or pediatric ICU, 89 respondents whose working time was less than 6 months, and 95 invalid respondents, and then there were finally 3 206 valid questionnaires and the response rate were 90.0%. Those 3 206 respondents included 616 doctors (19.2%), 2 371 nurses (74.0%), 129 respiratory therapists (4.0%), 51 physiotherapist (1.6%) and 39 dietitians (1.2%). The mean age was (30.7±6.3) years old. Most of them had bachelor's degree (65.9%), master and above was 14.1%. Associate senior physician and above was 8.0%; ICU working time was (5.94±4.50) years. In clinical practice, only 26.5% of the ICU medical staffs confirmed that they had treated or taken care for ICU-AW patients; 52.9% of medical staffs evaluated ICU-AW only based on clinical experience, and only 12.3% used ICU-AW assessment tools. The majority of respondents believed that ICU-AW knowledge training should be performed (81.8%), ICU-AW assessment should be as important as other complications (pressure sore, infected ventilator associated pneumonia, etc., 75.1%), and ICU-AW assessment should be part of daily treatment and care activities (61.2%). However, only 10.2% of respondents had received ICU-AW related knowledge training, and 42.7% respondents believed that their ICU-AW related knowledge could not meet clinical needs. Only 18.7% respondents would actively assess whether patients suffered from ICU-AW or not, and 42.3% respondents thought that ICU-AW should be assessed every day, and the assessment tools were also inconsistent. There were 44.0% respondents considered the Medical Research Council Muscle score (MRC-score) scale was the optimal tool for diagnosing ICU-AW, the following were neuro-electrophysiological examination (17.2%) and manual muscle strength (MMT, 11.1%). The main cause of the ICU-AW assessment barriers was the lack of ICU-AW related knowledge (88.1%), and the following were lack of ICU-AW assessment guidelines (76.5%), patients' cognitive impairment or limited understanding ability (84.6%), unable to cooperate with the assessment due to critical illness (83.0%), and inadequate attention to ICU-AW assessment by the department (77.5%).
The current status of ICU-AW assessment were unsatisfying in China, and the main barriers were lack of skills and knowledge.
调查重症监护病房获得性肌无力（ICU-AW）评估的现状，分析评估障碍，为改善ICU-AW评估提供参考。
采用方便抽样的横断面调查。首先，根据国内外相关文献并结合本研究目的设计访谈提纲。采用方便抽样方法，选取兰州大学第一医院重症监护病房（ICU）的13名医务人员（8名ICU护士、3名ICU医生、1名呼吸治疗师和1名物理治疗师）进行访谈。其次，对访谈主题进行综合分析和提炼，构建问卷，并对其信效度进行评估。最后，在中国实施包括ICU医务人员一般情况、ICU-AW现行做法及影响因素的问卷调查。
问卷的重测信度为0.92，专家效度为0.96。31个省、直辖市和自治区共有3563名受访者，剔除357份不合格问卷，其中包括173名新生儿或儿科ICU受访者、89名工作时间少于6个月的受访者以及95名无效受访者，最终获得有效问卷3206份，有效率为90.0%。这3206名受访者中，医生616名（19.2%），护士2371名（74.0%），呼吸治疗师129名（4.0%），物理治疗师51名（1.6%），营养师39名（1.2%）。平均年龄为（30.7±6.3）岁。大多数人拥有本科学历（65.9%），硕士及以上学历占14.1%。副主任医师及以上职称占8.0%；在ICU工作时间为（5.94±4.50）年。在临床实践中，只有26.5%的ICU医务人员确认曾治疗或护理过ICU-AW患者；52.9%的医务人员仅根据临床经验评估ICU-AW，只有12.3%的人使用ICU-AW评估工具。大多数受访者认为应开展ICU-AW知识培训（81.8%），ICU-AW评估应与其他并发症（压疮、呼吸机相关性肺炎等）评估同等重要（75.1%），ICU-AW评估应成为日常治疗和护理活动的一部分（61.2%）。然而，只有10.2%的受访者接受过ICU-AW相关知识培训，42.7%的受访者认为自己的ICU-AW相关知识无法满足临床需求。只有18.7%的受访者会主动评估患者是否患有ICU-AW，42.3%的受访者认为应每天评估ICU-AW，且评估工具也不一致。44.0%的受访者认为医学研究委员会肌肉评分（MRC评分）量表是诊断ICU-AW的最佳工具，其次是神经电生理检查（17.2%）和徒手肌力测试（MMT，11.1%）。ICU-AW评估障碍的主要原因是缺乏ICU-AW相关知识（88.1%），其次是缺乏ICU-AW评估指南（76.5%）、患者认知障碍或理解能力有限（84.6%）、病情危重无法配合评估（83.0%）以及科室对ICU-AW评估重视不足（77.5%）。
我国ICU-AW评估现状不尽人意，主要障碍是缺乏技能和知识。
