吴袁琴

【摘要】 目的：探讨医护一体化结合约束决策轮及等级在重症监护室（intensive care unit， ICU）患者约束中的护理效果。方法：选择2018年6月-2019年5月入住本院ICU的患者100例为研究对象。根据随机数字表法分为对照组和试验组，每组50例。试验组采用医护一体化结合约束决策轮及等级的约束护理方法，对照组行常规身体约束。比较两组患者身体约束使用率、不良事件发生情况、对护理的满意度情况。结果：试验组患者身体约束使用率为80.00%，明显低于对照组的94.00%，差异有统计学意义（P<0.05）。试验组不良事件总发生率为10.00%，低于对照组的30.00%，差异有统计学意义（P<0.05）。试验组对约束护理工作的总满意率为82.00%，高于对照组的56.00%，差异有统计学意义（P<0.05）。结论：医护一体化结合约束决策轮及等级在ICU患者约束中的效果较好，值得进一步在护理工作中推广。

【关键词】 医护一体化 约束决策轮及等级 重症监护 护理

[Abstract] Objective： To explore the nursing effect of the integration of medical treatment and nursing with constraint decision-making round and rank in the constraint of patients in intensive Care Unit （ICU）. Method： A total of 100 patients admitted to ICU in our hospital from June 2018 to May 2019 were selected as study subjects. According to the random number table method， the patients were divided into the control group and the experimental group， 50 cases in each group. The experimental group adopted the constrained nursing method of medical integration combined with the constraint decision-making round and rank， the control group received routine physical restraint. The utilization rate of physical restraint， the incidence of adverse events， and the satisfaction of doctors and patients family members on nursing were compared between the two groups. Result： The utilization rate of physical restraint in the experimental group was 80.00%， significantly lower than 94.00% in the control group， the difference was statistically significant （P<0.05）. The total incidence of adverse events in the experimental group was 10.00%， lower than 30.00% in the control group， the difference was statistically significant （P<0.05）. The total satisfaction rate of the experimental group was 82.00%， higher than 56.00% of the control group， the difference was statistically significant （P<0.05）. Conclusion： The effect of medical integration combined with constraint decision-making round and rank in ICU patient constraint is good， which is worth of further popularizing in nursing work.

[Key words] Medical integration Constraint decision-making round and rank Intensive care Nursing

First-authors address： Peoples Hospital of Pingxiang City， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2020.21.025

在重癥监护室（intensive care unit， ICU）中进行治疗的危重病患，常伴有意识障碍或多难以自觉配合治疗。且目前ICU中治疗设备众多、治疗环境特殊及封闭式管理，以上多种原因导致了对患者身体约束的使用率居高不下[1-2]。然而近年来越来越多的研究表明，在一线临床工作中对患者身体约束的过度使用、约束相关不良事件的发生及家属对于护理不满等相关方面存在诸多问题[3-4]。医护一体化结合约束决策轮及等级来评估患者身体约束情况，相较于以往的决策方式不但引入了医护一体共同决策，同时还吸收了美国医疗机构评审联合委员会（Joint Commission on Accreditation of Health care Organizations， JCAHO）制订提出的ICU约束决策轮及等级的决策理念[5-6]，从决策参与到科学依据均进行了全面提升，希望可以实现对ICU患者最为合理的约束决策，为临床工作提供参考和帮助。现报道如下。

1 资料与方法

1.1 一般资料 选择2018年6月-2019年5月入住本院ICU的患者100例为研究对象。……