ICU获得性肌无力的评估现状及阻碍评估的影响因素调查  

Current practice and obstacle factors of intensive care unit-acquired weakness assessment

作　　者：吴雨晨[1,2] 姜变通 王国强 魏花萍[1] 李斌[1] 申希平[3] 张彩云[1] 张志刚[1] 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;School of Public Health,Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]兰州大学第一医院重症医学科,兰州730000 [2]兰州大学护理学院,兰州730000 [3]兰州大学公共卫生学院,兰州730000

出　　处：《中华危重病急救医学》2020年第9期1111-1117,共7页Chinese Critical Care Medicine

基　　金：甘肃省自然科学基金(17JR5RA266)。

摘　　要：目的了解ICU获得性肌无力(ICU-AW)的评估现状,分析阻碍ICU-AW评估的影响因素,为完善ICU-AW评估提供参考.方法采用便利抽样横断面调查方法.首先,基于国内外相关文献,结合研究目的自行设计访谈提纲,采用便利抽样法抽取兰州大学第一医院重症监护病房(ICU)13名医务人员(ICU专科护士8名、临床医生3名、呼吸治疗师和康复治疗师各1名)进行访谈;然后,全面分析和提炼访谈主题,构建调查问卷并对其进行信度和效度检验;最后,对我国的ICU医务人员进行问卷调查,调查内容包括:ICU医务人员的一般情况、ICU-AW的评估现状和影响因素.结果调查问卷的复测信度为0.92,专家效度为0.96.共有31个省、市、自治区的3563名ICU医务人员参与调查,提交问卷3563份,剔除不合格问卷357份(包括被调查者来自新生儿或儿科ICU 173份、被调查者ICU工作时间<6个月89份、无效问卷95份),最终回收有效问卷3206份,有效回收率为90.0%.在3206名ICU医务人员中,医生616名(占19.2%),护士2371名(占74.0%),呼吸治疗师129名(占4.0%),康复治疗师51名(占1.6%),营养师39名(占1.2%);年龄(30.7±6.3)岁;文化程度以本科居多(65.9%),硕士及以上学历占14.1%;副高及以上职称占8.0%;ICU工作年限(5.94±4.50)年.在临床实践中,仅有26.5%的ICU医务人员确定自己曾经治疗或护理过ICU-AW患者;52.9%的医务人员仅凭临床经验来评估ICU-AW,使用ICU-AW评估工具的人群仅占12.3%.大多数ICU医务人员认为应接受ICU-AW相关专业培训(81.8%),应重视ICU-AW如同重视ICU其他并发症(压疮、感染、呼吸机相关性肺炎等,75.1%),并认为ICU-AW评估应纳入ICU日常诊疗活动(61.2%);但仅10.2%的医务人员接受过ICU-AW相关知识培训,高达42.7%的医务人员认为自身ICU-AW相关知识不能满足临床需要.仅18.7%的医务人员会主动评估患者是否发生ICU-AW;不足半数(42.3%)的医务人员认为应每天评估ICU-AW,且ICU评估工具Objective 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.Methods 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.Results The retest reliability was 0.92 and expert validity was 0.96 of the questionnaire.There were 3563 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 3206 valid questionnaires and the response rate were 90.0%.Those 3206 respondents included 616 doctors(19.2%),2371 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 I

关 键 词：ICU获得性肌无力 评估现状 障碍因素 

分 类 号：R746.1[医药卫生—神经病学与精神病学]