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重症监护病房身体约束的患病率及影响因素:一项回顾性队列研究

Prevalence and Influencing Factors of Physical Restraints in Intensive Care Units: A Retrospective Cohort Study.

作者信息

Cui Nianqi, Zhang Hui, Gan Sijie, Zhang Yuping, Chen Dandan, Guo Pingping, Wu Jingjie, Li Zhuang, Jin Jingfen

机构信息

Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People's Republic of China.

School of Nursing, Kunming Medical University, Kunming, Yunnan, People's Republic of China.

出版信息

Risk Manag Healthc Policy. 2023 May 19;16:945-956. doi: 10.2147/RMHP.S408919. eCollection 2023.

Abstract

PURPOSE

Physical restraints are used routinely in intensive care units (ICUs) and have negative effects. It is critical to identify the impact factors of physical restraints on critically ill patients. The present study investigated the prevalence of physical restraints and impact factors associated with their use in a large cohort of critically ill patients over one year.

PATIENTS AND METHODS

A retrospective cohort study was performed in multiple ICUs at a tertiary hospital in China in 2019 using observational data from electronic medical records. The data consisted of demographics and clinical variables. Logistic regression was used to assess the independent impact factors for the use of physical restraint.

RESULTS

The analysis consisted of 3776 critically ill patients with a prevalence of physical restraint use of 48.8%. The logistic regression analysis indicated that physical restraint use was associated with independent risk factors, including surgical ICU admission, pain, tracheal tube placement, and abdominal drainage tube placement. Physical restraint use was associated with independent protective factors, including male sex, light sedation, muscle strength, and ICU length of stay.

CONCLUSION

The prevalence of physical restraint use in critically ill patients was high. Tracheal tubes, surgical ICU, pain, abdominal drainage tubes, light sedation, and muscle strength were independent variables associated with the use of physical restraint. These results will assist health professionals in identifying high-risk physical restraint patients based on their impact factors. Early removal of the tracheal tube and abdominal drainage tube, pain relief, light sedation, and improvements in muscle strength may help reduce the use of physical restraints.

摘要

目的

在重症监护病房(ICU)中,身体约束措施被常规使用且存在负面影响。识别身体约束对重症患者的影响因素至关重要。本研究调查了一大群重症患者在一年多时间里身体约束的使用情况及其相关影响因素。

患者与方法

2019年在中国一家三级医院的多个ICU进行了一项回顾性队列研究,使用电子病历中的观察数据。数据包括人口统计学和临床变量。采用逻辑回归分析来评估使用身体约束的独立影响因素。

结果

分析纳入了3776例重症患者,身体约束的使用率为48.8%。逻辑回归分析表明,使用身体约束与独立危险因素相关,包括入住外科ICU、疼痛、气管插管和放置腹腔引流管。使用身体约束与独立保护因素相关,包括男性、轻度镇静、肌肉力量和ICU住院时间。

结论

重症患者身体约束的使用率较高。气管插管、外科ICU、疼痛、腹腔引流管、轻度镇静和肌肉力量是与使用身体约束相关的独立变量。这些结果将有助于医护人员根据影响因素识别身体约束的高危患者。尽早拔除气管插管和腹腔引流管、缓解疼痛、轻度镇静以及增强肌肉力量可能有助于减少身体约束的使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c78/10204753/7cb07af7b997/RMHP-16-945-g0001.jpg

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