ICU氣管內管病人接受身體約束之相關因素及預測因子

背景：加護病房（intersive care unit, ICU）氣管內管病人經常接受身體約束，身體約束之相關因素及預測因子值得探討。方法：採病歷回溯分析，收集南部某區域教學醫院六個ICU，2014年1月1日至6月30日共381位氣管內管病人，以自擬「ICU病人基本屬性及病房特性問卷」及「ICU病人接受身體約束紀錄表」收集資料。結果︰ICU氣管內管病人：（1）疾病愈嚴重者愈少接受身體約束，且疾病嚴重度愈輕者約束之總時數愈長；（2）意識愈清醒者愈多接受身體約束，且約束總時數愈長；（3）護病比愈高，身體約束的護理品質愈完整；（4）有呼吸系統疾病者（OR＝2.459，p＜.05）、APACHEⅡ（OR＝.937，p＜.01）、昏迷指數（OR＝1.237，p＜.001）及管路數量（OR＝1.273，p＜.05）為身體約束之預測因子。結論／實務應用：ICU氣管內管病人有呼吸系統疾病、APACHE II低、昏迷指數高、管路數量愈多者為身體約束之高危險群，醫護人員應密切觀察並擬定照護計畫，及早給予替代性約束措施。

關鍵字

身體約束；氣管內管病人；加護病房

並列摘要

Background: Patients with indwelling endotracheal tubes in intensive care units (ICU) often require physical restraints, therefor, the related factors of status in physical restraint and its predictors is worthy to exploring. Methods: This is a retrospective medical record review study. From January 1^(st) and June 30^(th), 2014, 381 patients with indwelling endotracheal tubes at six ICUs in one southern regional teaching hospital were eligible for this study. Two self-designed questionnaires, including ＂Demographic Data of the Patients and Characteristic of the ICU＂, ＂Nursing Logs for Patients with Physical Restraint in the ICU＂, were applied for data collection. Results: For patients with indwelling endotracheal tubes in the ICU: (1) Patients who had more severe diseases were less likely to require physical restraint. Patients who had milder diseases required longer physical restraint. (2) Patients with higher GCS scores were more likely to require longer physical restraint. (3) In the ICU ward, the higher the nurse-patient ratio, the better the quality of physical restraint. (4) Four predictors for patients with indwelling endotracheal tubes in the ICU who required physical restraint: respiratory disorders (OR=2.459, p＜.05), APACHE II (OR=.937, p＜.01), GCS score (OR=1.237, p＜.001) and number of tubes/catheters (OR=1.273，p＜.05). Conclusions/Implications for Practice: ICU patients, especially those diagnosed with respiratory disorders, or those with either lower APACHE II scores, higher GCS scores or multiple tubes/catheters, are high-risk populations for physical restraint. For reducing unnecessary restraint procedures, close monitoring and alternative restraint procedure must be provided as early as possible.