蛛网膜下腔出血患者身体约束需求与不良神经学结局之间的关联
Association between physical restraint requirement and unfavorable neurologic outcomes in subarachnoid hemorrhage.
作者信息
Akiyama Kyoko, Inoue Akihiko, Hifumi Toru, Nakamura Kentaro, Taira Takuya, Nakagawa Shun, Jinno Keisuke, Manabe Arisa, Kinugasa Sayaka, Matsumura Hikaru, Shishido Hajime, Yokoyama Shota, Okazaki Tomoya, Hamaya Hideyuki, Takano Koshiro, Kiridume Kazutaka, Shinohara Natsuyo, Kawakita Kenya, Kuroda Yasuhiro
机构信息
Department of Nursing, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaiganndori, Chuo-ku, Kobe, Hyogo, 651-0073, Japan.
出版信息
J Intensive Care. 2021 Mar 12;9(1):24. doi: 10.1186/s40560-021-00541-z.
BACKGROUND
Physical restraint has been commonly indicated to patients with brain dysfunction in neurocritical care. The effect of physical restraints on outcomes of critically ill adults remains controversial as no randomized controlled trials have compared its safety and efficacy, and the association between physical restraint requirement and neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been fully examined. The aim of this study was to examine the association between physical restraint requirement and neurological outcomes in patients with SAH.
METHODS
A single-center, retrospective study was conducted on patients with acute phase SAH treated for > 72 h in the intensive care unit from 2014 to 2020. Patients were divided into three groups based on the amount of time required for physical restraint during the first 24-72 h after admission: no, intermittent, and continuous use of physical restraint. Unfavorable neurologic outcome, assessed using the modified Rankin scale upon hospital discharge, has been considered as primary end point.
RESULTS
Overall, 101 patients were included in the study, with 52 patients (51.5%) having unfavorable neurological outcomes. Among them, 46 patients (45.5%) did not use physical restraint, and 55 (54.5%) patients used physical restraint during the first 24-72 h after admission: 26 (25.7%) intermittent and 29 (28.7%) continuous. Multivariable logistic regression analysis showed that continuous use of physical restraint during the first 24-72 h after admission was significantly associated with unfavorable neurological outcomes in patients with SAH (odds ratio, 3.54; 95% confidence interval, 1.05-13.06; p = 0.042) compared with no physical restraint.
CONCLUSIONS
Continuous use of physical restraint during the first 24-72 h after admission was more significantly associated with unfavorable neurological outcomes than no physical restraint among patients with SAH during the acute phase.
背景
在神经重症监护中，身体约束常用于脑功能障碍患者。由于尚无随机对照试验比较其安全性和有效性，因此身体约束对重症成年患者预后的影响仍存在争议，且蛛网膜下腔出血（SAH）患者身体约束需求与神经功能预后之间的关联尚未得到充分研究。本研究的目的是探讨SAH患者身体约束需求与神经功能预后之间的关联。
方法
对2014年至2020年在重症监护病房接受治疗超过72小时的急性期SAH患者进行单中心回顾性研究。根据入院后最初24 - 72小时内身体约束所需时间，将患者分为三组：未使用、间歇性使用和持续使用身体约束。以出院时使用改良Rankin量表评估的不良神经功能预后作为主要终点。
结果
总体而言，101例患者纳入研究，其中52例（51.5%）有不良神经功能预后。其中，46例（45.5%）未使用身体约束，55例（54.5%）患者在入院后最初24 - 72小时内使用身体约束：26例（25.7%）间歇性使用，29例（28.7%）持续使用。多变量逻辑回归分析显示，与未使用身体约束相比，入院后最初24 - 72小时内持续使用身体约束与SAH患者不良神经功能预后显著相关（比值比，3.54；95%置信区间，1.05 - 13.06；p = 0.042）。
结论
在急性期SAH患者中，入院后最初24 - 72小时内持续使用身体约束比未使用身体约束更显著地与不良神经功能预后相关。
Zotero 插件