基于eCASH理念成人心脏手术后患者身体约束缩减方案的构建与应用  

Construction and application of physical restraint reduction scheme for adult patients after cardiac surgery based on eCASH concept

作　　者：吕珊珊 郑静 刘先锋 郭绪英 武传妮 王慧慧 Lyu Shanshan;Zheng Jing;Liu Xianfeng;Guo Xuying;Wu Chuanni;Wang Huihui(Department of Cardiac Surgery Intensive Care Unit,Shandong Provincial Hospital Affiliated to Shandong First Medical University(Shandong Provincial Hospital),Jinan 250021,Shandong,China)

机构地区：[1]山东第一医科大学附属省立医院(山东省立医院)心外监护室,济南250021

出　　处：《中华危重病急救医学》2024年第10期1102-1107,共6页Chinese Critical Care Medicine

基　　金：山东省中医药科技项目(M-2022214)。

摘　　要：目的基于eCASH理念(即包括合理镇痛、最小化镇静剂使用及最大化人文关怀的早期舒适照护策略),构建成人心脏手术后患者身体约束缩减方案,并进行干预应用,探讨该方案的应用效果。方法采用非同期病例对照研究方法,选择2022年7月至10月山东第一医科大学附属省立医院心血管外科重症监护病房(ICU)收治的486例心脏手术后患者作为研究对象。根据身体约束缩减方案实施的时间节点,将7月至8月收治的250例患者作为对照组,9月至10月收治的236例患者作为观察组。对照组采用常规的身体约束护理流程,包括根据患者病情及意识遵医嘱选取适宜的约束器具,并按时检查,预防不良反应的发生;观察组实施以eCASH理念为基础的身体约束缩减方案,包括术前访视、术后依据约束决策轮及身体约束流程评估患者是否需要身体约束,并采取个体化护理方案。比较两组患者约束比例、约束时间、约束相关并发症(肢端水肿、约束区域皮肤红肿、皮肤破溃等)发生率、约束器具使用规范率、谵妄发生率及非计划性拔管事件发生率。结果两组患者年龄、性别、体外循环、气管导管留置时间及手术类型差异均无统计学意义,具有可比性。观察组患者约束比例较对照组明显降低〔16.95%(40/236)比84.40%(211/250),P<0.01〕,约束时间较对照组明显缩短〔h:0(0,1.0)比7.0(5.5,10.0),P<0.01〕,且约束相关并发症发生率和谵妄发生率均明显低于对照组〔约束相关并发症:0.85%(2/236)比1.60%(4/250),谵妄:0%(0/236)比2.80%(7/250),均P<0.05〕,约束器具使用规范率明显高于对照组〔100.00%(40/40)比90.52%(191/211),P<0.05〕;两组患者均无非计划性拔管事件发生。结论实施基于eCASH理念的成人心脏手术后患者身体约束缩减方案能够有效降低约束比例及约束相关并发症发生率,缩短约束时间,同时降低谵妄发生率,提升约束器具使用的规范�Objective To construct a physical restraint reduction scheme based on eCASH concept(that is early Comfort using Analgesia,minimal Sedatives and maximal Human care for adult patients after cardiac surgery,and intervene,and to evaluate its effectiveness.Methods A non-synchronous case-control study was conducted.A total of 486 patients after cardiac surgery admitted to the cardiac surgery intensive care Unit(ICU)of Shandong Provincial Hospital Affiliated to Shandong First Medical University from July to October 2022 were enrolled as subjects.According to the implementation time node of the physical restraint reduction scheme,250 patients admitted from July to August were served as the control group,and 236 patients admitted from September to October were served as the observation group.The control group adopted the routine physical restraint nursing process,including selecting the appropriate restraint device according to the patient's condition and consciousness and following the doctor's advice,and checking on time to prevent adverse reactions.The observation group implemented the physical restraint reduction scheme based on eCASH concept,including preoperative visit,postoperative assessment of whether patients needed physical restraint according to the restraint decision wheel and the physical restraint flow,and adopted personalized nursing programs.The restraint rate,restraint duration,incidence of restraint-related complication(edema of the limbs,redness and swelling of the skin in the restricted area,skin rupture,etc.),restraint device application standard rate,delirium rate and incidence of unplanned extubation event were compared between the two groups.Results There was no significant difference in age,gender,cardiopulmonary bypass,endotracheal catheter retention duration and operation type between the two groups with comparability.The restraint rate in the observation group was significantly lower than that in the control group[16.95%(40/236)vs.84.40%(211/250),P<0.01],and the restraint duration was signific

关 键 词：eCASH理念 心脏手术后 身体约束 

分 类 号：R473.6[医药卫生—护理学]