ICU患儿住院期间睡眠质量及影响因素的混合研究  

Mixed methods study of sleep quality and its influencing factors in children during ICU hospitalization

作　　者：范晓睿 顾莺 胡静 陈伟明 戚少丹 杨玉霞 沈伟杰 Fan Xiaorui;Gu Ying;Hu Jing;Chen Weiming;Qi Shaodan;Yang Yuxia;Shen Weijie(School of Nursing,Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学护理学院,上海201102 [2]复旦大学附属儿科医院护理部 [3]复旦大学附属儿科医院重症医学科

出　　处：《护理学杂志》2024年第24期20-24,30,共6页Journal of Nursing Science

基　　金：2023年度市级医院诊疗技术推广及优化管理项目(SHDC22023240);上海市卫生健康系统重点扶持学科项目(2023ZDFC0103)。

摘　　要：目的了解ICU患儿住院期间的睡眠质量及影响因素,为临床制订睡眠管理方案提供参考。方法采用一致并行式混合研究设计,纳入243例ICU患儿,采用儿童睡眠习惯问卷进行问卷调查,对睡眠、噪声及光线水平进行监测,同时采用目的抽样法对13例患儿进行半结构式访谈。结果ICU患儿夜间总睡眠时间为(6.50±1.23)h、睡眠效率为(78.75±15.39)%。夜间噪声>50 dB总时间、夜间医疗护理活动次数、累计置管数量,以及ICU住院时间、持续机械通气时间和持续镇静镇痛时间为ICU患儿睡眠效率的主要影响因素(均P<0.05)。质性访谈共提炼出2个主题10个亚主题:ICU患儿睡眠紊乱多发(入睡困难和睡眠效率低下、睡眠碎片化、昼夜节律颠倒、噩梦频繁)、多重因素共同影响患儿ICU住院睡眠质量(特殊物理环境的不良刺激、忍受持续治疗带来的痛苦、生理性不适感困扰、缺乏情绪支持和陪伴、睡眠环境和习惯突然改变、医疗护理活动频繁)。结论ICU患儿整体睡眠质量较差,医护人员应及时识别并积极干预,提高睡眠质量,促进患儿康复。Objective To understand the sleep quality and influencing factors during hospitalization of critically ill children in ICU,and to provide references for clinical development of sleep management programs.Methods A consistent parallel mixed research design was employed,involving 243 pediatric ICU patients.The Children′s Sleep Habits Questionnaire was used for surveys,and monitoring was conducted for sleep,noise,and light levels.Additionally,purposive sampling was utilized to conduct semi-structured interviews with 13 children.Results The total nighttime sleep duration of ICU children was(6.50±1.23)hours,with a sleep efficiency of(78.75±15.39)%.The duration of nighttime noise>50 dB,frequency of nighttime medical and nursing interventions,total number of catheter placements,ICU length of stay,duration of mechanical ventilation,and duration of sedation and analgesia were identified as the main influencing factors of sleep quality in ICU children(all P<0.05).Qualitative interviews revealed 2 themes and 10 subthemes:sleep disturbances were prevalent among ICU children(difficulty in falling asleep and low sleep efficiency,fragmented sleep,disrupted circadian rhythms,frequent nightmares),and multiple factors jointly affected the sleep quality of children hospitalized in the ICU(adverse stimuli from the unique physical environment,enduring pain from ongoing treatment,distress from physiological discomfort,lack of emotional support and companionship,sudden changes in sleep environment and habits,frequent medical and nursing activities).Conclusion Overall sleep quality is poor during ICU hospitalization in critically ill children,and healthcare professionals should promptly identify and actively intervene to improve their sleep quality and promote their recovery.

关 键 词：患儿 危重症 睡眠障碍 睡眠质量 机械通气 镇痛 镇静 混合研究 

分 类 号：R473.72[医药卫生—护理学]