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四川省ICU患者早期活动的实施现状调查及相关因素分析
Current status and related factors of early mobility among ICU patients in Sichuan Province

谢汶倚 吴孟航 唐荔 田永明

Xie Wenyi, Wu Menghang, Tang Li, Tian Yongming

【摘要】目的 探讨早期活动理念在四川省各ICU 中的推广及实践现状。方法 在查阅文献的基 础上,自行设计 ICU 患者早期活动实施现状调查问卷,选取四川省 18 个市的 103 所二甲及以上医院的 ICU 进行调查。结果 不同等级的医院在是否为大学附属医院、床位数和床位使用率方面差异有统计 学意义(P< 0.05)。在 70 个开展了早期活动的 ICU 中,有标准早期活动方案的 ICU 与无标准早期活动方 案的 ICU 在是否组建专项团队、是否对患者进行书面评估、是否签署早期活动知情同意以及是否具备紧 急预案方面,差异有统计学意义(P< 0.05)。单因素 Logistic 回归分析结果显示,在开展且有标准方案和 未开展 ICU 患者早期活动的 ICU 中,床位数、护床比、床位使用率、配备康复治疗师、配备呼吸治疗师、 实施每日唤醒、采用标准镇静评分是 ICU 患者早期活动开展的影响因素(P< 0.05);在开展但无标准方 案和未开展 ICU 患者早期活动的 ICU 中,护床比、配备康复治疗师、配备呼吸治疗师、实施每日唤醒是 ICU 患者早期活动开展的影响因素(P< 0.05)。多因素 Logistic 回归分析结果显示,护床比、床位使用率、 配备康复治疗师、配备呼吸治疗师为开展有标准方案早期活动的影响因素(P< 0.05);护床比、配备康复 治疗师、配备呼吸治疗师为开展无标准方案早期活动的影响因素(P< 0.05)。结论 四川省各ICU 中早 期活动的实施率仍不足,实施质量不理想。还需进一步探讨多学科合作方式,人力资源配置等相关问题, 早期活动形式有待进一步规范,需加强基于循证的临床实践和制定适合本土的方案。
【摘要】Objective To explore the popularization and practice ofearly mobility idea in Intensive Care Units (ICUs) in Sichuan Province. Methods Based on literature review, we designed the Early Mobility Implementation Questionnaires for ICU patients by ourselves. We selected ICUs at 103 Class Ⅱ Grade A and above hospitals in 18 cities, Sichuan Province, to carry out the survey. Results There were statistical differences in different levels hospitals whether it was from an affiliated hospital of a university, with different numbers of beds and bed utilization rates (P < 0.05). Among 70 ICUs that developed the early mobility, there were statistical differences in early mobility implementation of patients in the ICU whether to form a special team, whether to conduct a written evaluation for patients, whether to sign the early mobility informed consent and whether there was an emergency plan (P < 0.05). Between ICUs with early mobility of ICU patients and standard plan, and ICUs without early mobility, single factor Logistic regression analysis showed that the influencing factors of early mobility implementation of ICU patients included the numbers of beds, nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists, implementing the daily interruption as well as sedation score with statistical differences (P < 0.05); between ICUs with early mobility of ICU patients and without standard plan, and ICUs without early mobility, the influencing factors of early mobility implementation of ICU patients included the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists and implementing the daily interruption with statistical differences (P < 0.05). Multivariate Logistic regression analysis indicated that the influencing factors of early mobility implementation with standard plan were the nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists with statistical differences (P< 0.05); the influencing factors of early mobility implementation without standard plan were the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists with statistical differences (P< 0.05). Conclusions The implementation rate of early mobility in ICU is still insufficient in Sichuan Province, and implementation quality is no ideal. We should further explore the relevant issues, such as multidisciplinary cooperation as well as human resource allocation, and improve the early mobility forms, strengthen the evidence-based clinical practice and formulate a scheme suitable for China.

【关键词】重症监护病房; 早期活动; 调查研究
【关键词】Intensive care unit; Early mobility; Survey and research