不同身体约束情况及约束方式约束效果的系统评价
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摘要
[目的]系统评价不同约束情况及约束方式的约束效果。[方法]系统检索PubMed、The Cochrane Library、EMBASE、EBSCO、Ovid、中国学术期刊全文数据库、中国生物医学文献数据库、中国科技期刊数据库中关于不同身体约束情况及约束方式的约束效果对比研究,检索时间为建库至2017年8月1日。按照纳入及排除标准筛选文献、提取资料并评价纳入文献的方法学质量。采用RevMan 5.2软件对数据进行分析。[结果]共纳入18项研究,Meta分析结果显示:约束病人非计划性拔管发生率高于非约束病人[OR=2.53,95%CI(1.74, 3.67),P<0.000 01],改进约束用具病人非计划性拔管发生率[OR=0.14,95%CI(0.08, 0.25),P<0.000 01]、皮肤受损发生率[OR=0.08,95%CI(0.04, 0.15),P<0.000 01]、约束松脱发生率[OR=0.21,95%CI(0.06,0.78),P=0.02]低于传统约束用具病人,优化约束流程病人非计划性拔管发生率[OR=0.09,95%CI(0.04, 0.20),P<0.000 01]、皮肤受损发生率[OR=0.26,95%CI(0.16,0.42),P<0.000 01]、血液循环障碍发生率[OR=0.17,95%CI(0.06,0.48),P=0.000 7]低于常规约束流程病人。描述性分析结果显示:观察组病人满意度均高于对照组病人(P<0.05)。[结论]现有证据表明:与非约束相比,约束并不能有效降低非计划性拔管发生率,但是针对约束病人,改进约束工具、优化约束流程有利于降低病人非计划性拔管发生率、皮肤受损发生率、血液循环障碍发生率及约束松脱发生率,提高病人满意度。
Objective:To evaluate the restraint effects of different physical restraints and restraint modes.Methods:Databases including PubMed,The Cochrane Library,EMBASE,EBSCO,Ovid,CNKI,CBMdisc,VIP were searched systematically from inception to August 1,2017 to collect the comparative study on the restraint effects of different physical restraints and restraint modes.Literatures were screened according to inclusion and exclusion criteria,data were extracted and methodological quality was evaluated.Meta analysis was performed using RevMan 5.2 software.Results:A total of 18 studies were included.Meta analysis showed that the incidence of unplanned extubation in patients with restraint was higher than those patients with non-restraint[OR=2.53,95%CI(1.74,3.67),P<0.000 01],the incidence of unplanned extubation[OR=0.14,95%CI(0.08,0.25),P<0.000 01],incidence of skin damage[OR=0.08,95%CI(0.04,0.15),P<0.000 01]and incidence of restraint loosening[OR=0.21,95%CI(0.06,0.78),P=0.02] in patients with improving restraint devices were lower than those in patients with traditional restraint devices,the incidence of unplanned extubation[OR=0.09,95%CI(0.04,0.20),P<0.000 01],skin damage[OR=0.26,95%CI(0.16,0.42),P<0.000 01] and blood circulation disorder[OR=0.17,95%CI(0.06,0.48),P=0.000 7] in patients with optimizing restraint process were lower than those in patients with routine optimizing restraint process.Descriptive analysis showed that the satisfaction of patients in observation group was higher than those in control group(P<0.05).Conclusion:Present evidences showed that compared with non-restraint,restraint couldn′t reduce the incidence of unplanned extubation.But for restrained patients,it was favorable for reducing the incidences of unplanned extubation,skin damage,blood circulation disorder and constrained loosening,improving satisfaction of patients with improving restraint devices and optimizing restraint process.
Objective:To evaluate the restraint effects of different physical restraints and restraint modes.Methods:Databases including PubMed,The Cochrane Library,EMBASE,EBSCO,Ovid,CNKI,CBMdisc,VIP were searched systematically from inception to August 1,2017 to collect the comparative study on the restraint effects of different physical restraints and restraint modes.Literatures were screened according to inclusion and exclusion criteria,data were extracted and methodological quality was evaluated.Meta analysis was performed using RevMan 5.2 software.Results:A total of 18 studies were included.Meta analysis showed that the incidence of unplanned extubation in patients with restraint was higher than those patients with non-restraint[OR=2.53,95%CI(1.74,3.67),P<0.000 01],the incidence of unplanned extubation[OR=0.14,95%CI(0.08,0.25),P<0.000 01],incidence of skin damage[OR=0.08,95%CI(0.04,0.15),P<0.000 01]and incidence of restraint loosening[OR=0.21,95%CI(0.06,0.78),P=0.02] in patients with improving restraint devices were lower than those in patients with traditional restraint devices,the incidence of unplanned extubation[OR=0.09,95%CI(0.04,0.20),P<0.000 01],skin damage[OR=0.26,95%CI(0.16,0.42),P<0.000 01] and blood circulation disorder[OR=0.17,95%CI(0.06,0.48),P=0.000 7] in patients with optimizing restraint process were lower than those in patients with routine optimizing restraint process.Descriptive analysis showed that the satisfaction of patients in observation group was higher than those in control group(P<0.05).Conclusion:Present evidences showed that compared with non-restraint,restraint couldn′t reduce the incidence of unplanned extubation.But for restrained patients,it was favorable for reducing the incidences of unplanned extubation,skin damage,blood circulation disorder and constrained loosening,improving satisfaction of patients with improving restraint devices and optimizing restraint process.
引文
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[10] CHANG L Y,WANG K W,CHAO Y F.Influence of physical restraint on unplanned extubation of adult intensive care patients:a case-control study[J].Am J Crit Care,2008,17(5):408-416.
[11] 封苏平,郑红,姜国英.保护性约束对脑损伤躁动患者意外拔管的预防效果[J].解放军护理杂志,2010,27(3A):343-347.
[12] 伍林飞,廖燕,虞献敏.个性化约束在危重患者护理中的应用[J].护理学杂志,2011,26(9):36-37.
[13] 许雪华,刘莉,吴怡卿,等.球拍式约束带预防置管患者管道拔脱的效果观察[J].护理学报,2011,18 (2A):66-68.
[14] CHANG L C,LIU P F,HUANG Y L,et al.Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients:a 3-year retrospective case-control study[J].Appl Nurs Res,2011,24(3):188-192.
[15] 戴莉敏,贡浩凌,高燕,等.JCI标准在住院患者使用约束具安全管理中的应用[J].中国护理管理,2014,14(4):406-409.
[16] 陆利芳,唐志娟,赵良晴,等.保护性约束在关节科高龄患者意外拔管案例中的效果分析[J].基层医学论坛,2014,18(4):411-412.
[17] 李洁.危重患者护理中个体化约束的应用解析[J].基层医学论坛,2015,19(13):1830-1831.
[18] 刘桂娟.个性化约束在脑血管意外患者风险护理中的应用[J].内蒙古医学杂志,2015,47(7):874-875.
[19] 陈晓红,勇琴歌.两种约束方式在临床中的应用效果[J].解放军护理杂志,2015,32(5):69-71.
[20] 居丽.球拍式约束带预防ICU患者非计划性拔管的效果观察与体会[J].湖南中医杂志,2015,31(5):128-129.
[21] 傅园美.手袖套式约束带在躁动患者中的应用[J].护理实践与研究,2016,13(19):119-121.
[22] 刘伟迎,杨丽娇,申小英,等.防抓的约束手套对降低意外拔管率疗效观察[J].中国实用医药,2016,11(20):290-291.
[23] 徐笑月,王黎梅,张美琪,等.新型透明约束保护手套临床实用性的观察[J].护理与康复,2016,33(18):71-73.
[24] 董娟.防抓脱约束手套在神经外科躁动患者非计划性拔管中的应用[J].当代护士(下旬刊),2017(6):86-88.
[25] 李艳芬.保护性约束临床路径护理在神经外科颅脑损伤躁动患者中的应用[J].齐鲁护理杂志,2017,23(6):76-78.
[2] CURRY K,COBB S,KUTASH M,et al.Characteristics associated with unplanned extubations in a surgical intensive care unit[J].Am J Crit Care,2008,17(1):45-51.
[3] DE LASSENCE A,ALBERTI C,AZOULAY E,et al.Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit:a prospective multicenter study[J].Anesthesiology,2002,97(1):148-156.
[4] BRAY K,HILL K,ROBSON W,et al.British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units[J].Nursing in Critical Care,2004,9(5):199-212.
[5] 黄德钦,曾铁英.ICU病人身体约束真实体验的质性研究[J].护理研究,2015,29(2A):426-429.
[6] HIGGINS J P T,GREEN S.Cochrane handbook for systematic reviews of interventions version 5.1.0.[M].London:The Cochrane Collaboration,2011.
[7] 刘鸣.系统评价、Meta-分析设计与实施方法[M].北京:人民卫生出版社,2011:72-73;100.
[8] ATKINS P M,MION L C,MENDELSON W,et al.Characteristics and outcomes of patients who self-extubate from ventilatory support:a case-control study[J].Chest,1997,112(5):1317-1323.
[9] CHEVRON V,MENARD J F,RICHARD J C,et al.Unplanned extubation:risk factors of development and predictive criteria for reintubation[J].Crit Care Med,1998,26(6):1049-1053.
[10] CHANG L Y,WANG K W,CHAO Y F.Influence of physical restraint on unplanned extubation of adult intensive care patients:a case-control study[J].Am J Crit Care,2008,17(5):408-416.
[11] 封苏平,郑红,姜国英.保护性约束对脑损伤躁动患者意外拔管的预防效果[J].解放军护理杂志,2010,27(3A):343-347.
[12] 伍林飞,廖燕,虞献敏.个性化约束在危重患者护理中的应用[J].护理学杂志,2011,26(9):36-37.
[13] 许雪华,刘莉,吴怡卿,等.球拍式约束带预防置管患者管道拔脱的效果观察[J].护理学报,2011,18 (2A):66-68.
[14] CHANG L C,LIU P F,HUANG Y L,et al.Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients:a 3-year retrospective case-control study[J].Appl Nurs Res,2011,24(3):188-192.
[15] 戴莉敏,贡浩凌,高燕,等.JCI标准在住院患者使用约束具安全管理中的应用[J].中国护理管理,2014,14(4):406-409.
[16] 陆利芳,唐志娟,赵良晴,等.保护性约束在关节科高龄患者意外拔管案例中的效果分析[J].基层医学论坛,2014,18(4):411-412.
[17] 李洁.危重患者护理中个体化约束的应用解析[J].基层医学论坛,2015,19(13):1830-1831.
[18] 刘桂娟.个性化约束在脑血管意外患者风险护理中的应用[J].内蒙古医学杂志,2015,47(7):874-875.
[19] 陈晓红,勇琴歌.两种约束方式在临床中的应用效果[J].解放军护理杂志,2015,32(5):69-71.
[20] 居丽.球拍式约束带预防ICU患者非计划性拔管的效果观察与体会[J].湖南中医杂志,2015,31(5):128-129.
[21] 傅园美.手袖套式约束带在躁动患者中的应用[J].护理实践与研究,2016,13(19):119-121.
[22] 刘伟迎,杨丽娇,申小英,等.防抓的约束手套对降低意外拔管率疗效观察[J].中国实用医药,2016,11(20):290-291.
[23] 徐笑月,王黎梅,张美琪,等.新型透明约束保护手套临床实用性的观察[J].护理与康复,2016,33(18):71-73.
[24] 董娟.防抓脱约束手套在神经外科躁动患者非计划性拔管中的应用[J].当代护士(下旬刊),2017(6):86-88.
[25] 李艳芬.保护性约束临床路径护理在神经外科颅脑损伤躁动患者中的应用[J].齐鲁护理杂志,2017,23(6):76-78.