Wen Shouqin, Guo Linglin, You Qian, Chen Juan, Fang Jinbo
West China School of Nursing, Sichuan University/Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.
BMC Psychiatry. 2025 May 30;25(1):554. doi: 10.1186/s12888-025-06969-z.
Mechanical restraint, a widely utilized yet contentious restrictive intervention in psychiatric practice, adversely affects both physical and psychological well-being of patients. Understanding the determinants associated with its implementation is crucial for reducing its clinical application. Current studies have primarily evaluated factors influencing mechanical restraint use and related organizational adaptations, but these investigations are limited to short-term observations. Furthermore, research examining correlates in patients subjected to recurrent mechanical restraint episodes in open psychiatric wards remains scarce, with biological contributing factors particularly lacking empirical evidence.
This study aimed to analyze differences between inpatients experiencing single versus multiple restraint episodes in the open psychiatric ward setting and identify factors associated with multiple restraint occurrences.
This study is a retrospective analysis of electronic health record data from patients who underwent mechanical restraint in the open psychiatric ward of a Class III Grade A general hospital in China between 2016 and 2021. The data encompassed sociodemographic information, clinical characteristics, and biological indicators.
The study included a total of 449 patients who underwent mechanical restraint during hospitalization. Of these, 63.5% experienced a single episode of restraint, while 36.5% experienced multiple episodes. Furthermore, compared to patients with a single episode of mechanical restraint, those with multiple episodes exhibited a significantly earlier timing of the first restraint (p = 0.011), a prolonged hospital stay (p = 0.044), and relatively higher creatine kinase levels (p = 0.008). Multivariate analysis identified the timing of restraint (OR: 0.947, p = 0.005) and the duration of hospitalization (OR: 1.034, p = 0.003) as significant predictors of multiple restraint episodes.
Among psychiatric inpatients in open wards, those subjected to multiple restraints exhibited earlier occurrence of the first restraint after admission, prolonged hospital stays, and relatively higher serum creatine kinase levels at admission. These findings suggest that in clinical practice, repeated restraint may potentially prolong hospitalization duration. Monitoring serum creatine kinase levels at admission may aid in identifying patients at risk for repeated restraints. Furthermore, early risk identification and the implementation of alternative interventions are critical to reducing the necessity for restraint interventions.
机械约束是精神科实践中一种广泛使用但颇具争议的限制性干预措施，会对患者的身心健康产生不利影响。了解与其实施相关的决定因素对于减少其临床应用至关重要。目前的研究主要评估了影响机械约束使用的因素以及相关的组织适应性，但这些调查仅限于短期观察。此外，对开放式精神科病房中反复经历机械约束事件的患者的相关因素研究仍然很少，尤其是生物学影响因素缺乏实证依据。
本研究旨在分析开放式精神科病房中经历单次与多次约束事件的住院患者之间的差异，并确定与多次约束发生相关的因素。
本研究是对2016年至2021年期间在中国一家三级甲等综合医院开放式精神科病房接受机械约束治疗的患者的电子健康记录数据进行的回顾性分析。数据包括社会人口学信息、临床特征和生物学指标。
该研究共纳入449例住院期间接受机械约束的患者。其中，63.5%经历过单次约束，36.5%经历过多次约束。此外，与单次机械约束患者相比，多次约束患者首次约束的时间明显更早（p = 0.011），住院时间更长（p = 0.044），肌酸激酶水平相对较高（p = 0.008）。多因素分析确定约束时间（OR：0.947，p = 0.005）和住院时间（OR：1.034，p = 0.003）是多次约束事件的重要预测因素。
在开放式病房的精神科住院患者中，多次受到约束的患者入院后首次约束发生时间更早，住院时间更长，入院时血清肌酸激酶水平相对较高。这些发现表明，在临床实践中，反复约束可能会延长住院时间。入院时监测血清肌酸激酶水平可能有助于识别有反复约束风险的患者。此外，早期风险识别和实施替代干预措施对于减少约束干预的必要性至关重要。
