约束决策轮及等级评估在ICU意识障碍患者中的应用效果(1)
[摘要] 目的 探究约束决策轮及等级评估在ICU意识障碍患者中的应用效果。 方法 选取2018年2月～2019年2月江苏省海安市人民医院收治的ICU意识障碍患者120例，按随机数字表法将其分为对照组和观察组，每组各60例。对照组给予常规约束，观察组给予约束决策及等级评估进行约束，比较两组身体约束使用率、不良事件发生率及临床满意度。 结果 观察组干预后身体约束使用率低于对照组，观察组干预后不良事件发生率低于对照组，观察组干预后临床满意度高于对照组(P < 0.05)。 结论 约束决策轮及等级评估用于ICU意识障碍患者的临床干预中，可有效降低其身体约束使用率与不良事件发生率，提高临床满意度，值得推广。
[关键词] 约束决策轮;等级评估;ICU;意识障碍;身体约束
[中图分类号] R741 [文献标识码] A [文章编号] 1673-7210(2020)03(a)-0189-04
[Abstract] Objective To explore the application effect of constraint decision-making wheel and grade evaluation in ICU patients with disturbance of consciousness. Methods From February 2018 to February 2019， a total of 120 ICU patients with consciousness disorder admitted to Hai′an People′s Hospital in Jiangsu Province were selected， while divided into control group and observation group according to the random number table method， with 60 cases in each group. The control group was given conventional constraints， while the observation group was given constraints constraint decision and grade evaluation. The utilization rate of physical restraint， incidence of adverse events and clinical satisfaction were compared between the two groups. Results The use rate of physical constraints after intervention in the observation group was lower than that in the control group， the incidence of adverse events after intervention was lower in the observation group than in the control group， and the clinical satisfaction after intervention in the observation group was higher than that in the control group (P < 0.05). Conclusion In the clinical intervention of ICU patients with consciousness disorder， the constraint decision-making wheel and grade assessment can effectively reduce the utilization rate of physical restraint and the incidence of adverse events， and improve clinical satisfaction， which is worthy of promotion.
[Key words] Constraint decision-making wheel; Grade assessment; Intensive care unit; Consciousness disorder; Physical constraints
ICU患者多為危重症患者，而ICU意识障碍患者若无人陪护，易出现非计划拔管、肢端水肿等事件。临床上认为身体约束是预防ICU意识障碍患者出现意外事件的主要干预措施之一[1-2]。给予患者身体约束，难免会使患者的生理、心理等方面受到影响，因此在给予患者身体约束时需更为谨慎。目前，临床上对于ICU意识障碍患者主要参照《约束护理单》[3]对其身体情况进行评估后给予约束，但该方式并未结合患者的行为、独立能力及环境设施等实际情况，常出现约束不及时或过度约束等情况，极易出现约束部位皮肤异常等现象，使预后效果不佳[4]。ICU约束决策轮与等级评估最早由美国医疗认证体系(JACHO)，医院相关人员通过约束决策轮与等级评估为ICU患者的实际情况进行评估，进而对其患者的身体约束必要性作出准确评估，并在评估后按照患者的评估结果判断是否对其实施身体约束，该方式在降低ICU意识障碍患者的身体约束使用率与不良事件发生率等方面起着重要作用[5]。为探究其应用于ICU意识障碍患者更有效的干预方式，本研究将约束决策轮及等级应用于ICU意识障碍患者中，并探究约束决策轮及等级评估对患者身体约束使用率、不良事件发生率与临床满意度等指标的影响。结果报道如下：, http://www.100md.com(钱小丽 周玲华 王敏)
[关键词] 约束决策轮;等级评估;ICU;意识障碍;身体约束
[中图分类号] R741 [文献标识码] A [文章编号] 1673-7210(2020)03(a)-0189-04
[Abstract] Objective To explore the application effect of constraint decision-making wheel and grade evaluation in ICU patients with disturbance of consciousness. Methods From February 2018 to February 2019， a total of 120 ICU patients with consciousness disorder admitted to Hai′an People′s Hospital in Jiangsu Province were selected， while divided into control group and observation group according to the random number table method， with 60 cases in each group. The control group was given conventional constraints， while the observation group was given constraints constraint decision and grade evaluation. The utilization rate of physical restraint， incidence of adverse events and clinical satisfaction were compared between the two groups. Results The use rate of physical constraints after intervention in the observation group was lower than that in the control group， the incidence of adverse events after intervention was lower in the observation group than in the control group， and the clinical satisfaction after intervention in the observation group was higher than that in the control group (P < 0.05). Conclusion In the clinical intervention of ICU patients with consciousness disorder， the constraint decision-making wheel and grade assessment can effectively reduce the utilization rate of physical restraint and the incidence of adverse events， and improve clinical satisfaction， which is worthy of promotion.
[Key words] Constraint decision-making wheel; Grade assessment; Intensive care unit; Consciousness disorder; Physical constraints
ICU患者多為危重症患者，而ICU意识障碍患者若无人陪护，易出现非计划拔管、肢端水肿等事件。临床上认为身体约束是预防ICU意识障碍患者出现意外事件的主要干预措施之一[1-2]。给予患者身体约束，难免会使患者的生理、心理等方面受到影响，因此在给予患者身体约束时需更为谨慎。目前，临床上对于ICU意识障碍患者主要参照《约束护理单》[3]对其身体情况进行评估后给予约束，但该方式并未结合患者的行为、独立能力及环境设施等实际情况，常出现约束不及时或过度约束等情况，极易出现约束部位皮肤异常等现象，使预后效果不佳[4]。ICU约束决策轮与等级评估最早由美国医疗认证体系(JACHO)，医院相关人员通过约束决策轮与等级评估为ICU患者的实际情况进行评估，进而对其患者的身体约束必要性作出准确评估，并在评估后按照患者的评估结果判断是否对其实施身体约束，该方式在降低ICU意识障碍患者的身体约束使用率与不良事件发生率等方面起着重要作用[5]。为探究其应用于ICU意识障碍患者更有效的干预方式，本研究将约束决策轮及等级应用于ICU意识障碍患者中，并探究约束决策轮及等级评估对患者身体约束使用率、不良事件发生率与临床满意度等指标的影响。结果报道如下：, http://www.100md.com(钱小丽 周玲华 王敏)