三级医院ICU护士对ICU获得性衰弱评估及预防策略实践现状的调查研究

doi:10.3761/j.issn.2096-7446.2024.04.002

摘要/Abstract

摘要： 目的调查三级医院ICU护士对ICU获得性衰弱（intensive care unit acquired weakness,ICU-AW）评估及预防策略实践现状,并分析影响因素。方法采用便利抽样法,于2022年11月—12月选取北京市、辽宁省、河北省28所三级医院的397名护士为调查对象,采用自行设计的问卷进行调查。结果 ICU-AW评估主要由医生完成（55.42%）,肌力评估是首选方法（65.49%）。84.13%护士反映临床未有ICU-AW相关的标准化策略或流程,主要预防措施是镇痛镇静（65.24%）、早期活动（62.47%）,活动形式主要是呼吸功能指导（33.00%）、床上被动训练（33.25%）。护士ICU-AW评估与预防策略认知得分为（20.74±8.03）分,态度得分（26.68±4.19）分,实践得分（29.79±5.40）分。年龄、工作年限、学历、医院地区分布是护士对ICU-AW评估与预防措施实践的影响因素（P<0.05）。结论目前护士对ICU-AW认知水平不足,ICU-AW评估方式受限,缺乏标准化干预流程,人力资源不足。建议加强ICU-AW教育培训,完善资源配置,构建标准化的评估和实践流程,促进ICU-AW评估与预防实践的临床开展。

关键词: ICU获得性衰弱, 护士, 评估, 预防措施, 现状调查, 影响因素分析

Abstract: Objective To describe the status of the assessment and implementation of prevention strategies for intensive care unit acquired weakness（ICU-AW） among nurses in the tertiary hospitals,analyze the barriers that affected the practice. Methods A self-designed questionnaire was used to investigate 397 ICU nurses of 28 tertiary hospitals in Beijing,Liaoning Province and Hebei Province from November to December 2022 by convenient sampling. Results The clinical ICU-AW assessment was mainly completed by doctors（55.42%）. Muscle strength was the first choice for the evaluation of ICU-AW（65.49%）. 84.13% of nurses reported that there was no standardized strategy or process related to ICU-AW,and the main preventions were analgesia and sedation（65.24%）,early mobilization（62.47%）. The main forms of activity were respiratory function exercise（33.00%） and passive training in bed（33.25%）. The cognitive score of nurses in ICU-AW assessment and prevention strategy was （20.74±8.03）,attitude score was（26.68±4.19） and practice score was（29.79±5.40）. Age,working years,educational background and regional distribution of hospital were the influencing factors of nurses on ICU-AW assessment and prevention practice（P<0.05）. Conclusion Nursing staff's cognition level of ICU-AW is insufficient,assessment methods of ICU-AW are limited,standardized intervention procedures are lacking,and human resources are insufficient. Education and training of ICU-AW should be strengthened,resources allocation should be improved,and standardized assessment and practice procedures should be constructed to promote the clinical implementation of assessment and prevention practices of ICU-AW.

Key words: Intensive Care Unit Acquired Weakness, Nurses, Assessment, Prevention, Investigation, Route Cause Analysis

吕露露, 张雪静, 李文雄. 三级医院ICU护士对ICU获得性衰弱评估及预防策略实践现状的调查研究[J]. 中华急危重症护理杂志, 2024, 5(4): 298-304.

LÜ Lulu, ZHANG Xuejing, LI Wenxiong. Study on the assessment and prevention practice status of ICU acquired weakness among ICU nurses in tertiary hospitals[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(4): 298-304.

参考文献

[1] Hermans G,van den Berghe G. Clinical review:intensive care unit acquired weakness[J]. Crit Care,2015,19(1):274.
[2] Fan E,Cheek F,Chlan L,et al.An official American Thoracic Society clinical practice guideline:the diagnosis of intensive care unit-acquired weakness in adults[J]. Am J Respir Crit Care Med,2014,190(12):1437-1446.
[3] Panahi A,Malekmohammad M,Soleymani F,et al.The prevalence and outcome of intensive care unit acquired weakness(ICUAW)[J]. Tanaffos,2020,19(3):250-255.
[4] Sidiras G,Patsaki I,Karatzanos E,et al.Long term follow-up of quality of life and functional ability in patients with ICU acquired Weakness-A post hoc analysis[J]. J Crit Care,2019,53:223-230.
[5] 倪莹莹,王首红,宋为群,等. 神经重症康复中国专家共识(上)[J]. 中国康复医学杂志,2018,33(1):7-14.
Ni YY,Wang SH,Song WQ,et al.Expert consensus of severe neurological rehabilitation in China(Ⅰ)[J]. Chin J Rehabil Med,2018,33(1):7-14.
[6] Kress JP,Hall JB.ICU-acquired weakness and recovery from critical illness[J]. N Engl J Med,2014,371(3):287-288.
[7] Parry SM,Nydahl P,Needham DM.Implementing early physical rehabilitation and mobilisation in the ICU:institutional,clinician,and patient considerations[J]. Intensive Care Med,2018,44(4):470-473.
[8] 蔡雨清,徐艳玲,陈娅妮. ICU护士的ICU获得性衰弱知信行现状调查及影响因素分析[J]. 护理管理杂志,2019,19(4):251-254,266.
Cai YQ,Xu YL,Chen YN.Investigation on knowledge and behavior of ICU acquired frailty in ICU nurses and analysis of Influencing factors[J]. J Nurs Manag,2019,19(4):251-254,266.
[9] Klawitter F,Oppitz MC,Goettel N,et al.A global survey on diagnostic,therapeutic and preventive strategies in intensive care unit-acquired weakness[J]. Medicina(Kaunas),2022,58(8):1068.
[10] 李峥,刘宇. 护理学研究方法[M]. 北京:人民卫生出版社,2012:82-83.
Li Z,Liu Y.Nursing research methods[M]. Beijing:People's Medical Publishing House,2012:82-83.
[11] Kelmenson DA,Quan DN,Moss M.What is the diagnostic ac-curacy of single nerve conduction studies and muscle ultra-sound to identify critical illness polyneuromyopathy:a prospec-tive cohort study[J]. Crit Care,2018,22(1):342.
[12] 杨富,方芳. ICU获得性衰弱诊断与评估的研究进展[J]. 中华危重病急救医学,2021,33(12):1533-1536.
Yang F,Fang F.Research progress in diagnosis and evalua-tion of intensive care unit-acquired weakness[J]. Chin Crit Care Med,2021,33(12):1533-1536.
[13] 靳祥云,刘文伟,宿连政,等. 重症患者ICU获得性衰弱的研究概况[J]. 内科,2021,16(5):636-639,687.
Jin XY,Liu WW,Su LZ,et al.General situation of research on ICU acquired weakness in critically ill patients[J]. Intern Med China,2021,16(5):636-639,687.
[14] van Aerde N,Meersseman P,Debaveye Y,et al. Five-year impact of ICU-acquired neuromuscular complications:a prospective,observational study[J]. Intensive Care Med,2020,46(6):1184-1193.
[15] 王欢,石晶晶,薄荣强,等. ICU获得性衰弱研究进展的可视化分析研究[J]. 浙江医学,2021,43(22):2460-2464.
Wang H,Shi JJ,Bo RQ,et al.Visualized analysis of the research progress of intensive care unit-acquired weakness[J]. Zhejiang Med J,2021,43(22):2460-2464.
[16] 武宁,谭雅琼,李乐之. ICU获得性衰弱的护理研究现状[J]. 护理管理杂志,2019,19(4):241-245.
Wu N,Tan YQ,Li LZ.Research progress on nursing of ICU-acquired weakness[J]. J Nurs Adm,2019,19(4):241-245.
[17] Dirkes SM,Kozlowski C.Early mobility in the intensive care unit:evidence,barriers,and future directions[J]. Crit Care Nurse,2019,39(3):33-42.
[18] Ely EW.Early active mobilization during mechanical ventilation in the ICU[J]. N Engl J Med,2023,388(6):572.
[19] Menges D,Seiler B,Tomonaga Y,et al.Systematic early versus late mobilization or standard early mobilization in mechanical-ly ventilated adult ICU patients:systematic review and meta-analysis[J]. Crit Care,2021,25(1):16.
[20] 中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志,2017,36(3):251-256.
Geriatric Medicine Branch of Chinese Medical Association. Chinese experts consensus on assessment and intervention for elderly patients with frailty[J]. Chin J Geriatr,2017,36(3):251-256.
[21] 谢霖,罗健,李苗苗,等. ICU护士对ICU获得性肌无力认知的研究进展[J]. 护理学杂志,2017,32(16):107-110.
Xie L,Luo J,Li MM,et al.ICU nurses' cognition on ICU acquired weakness:a literature review[J]. J Nurs Sci,2017,32(16):107-110.
[22] 吴利,王建宁. ICU护士对ICU获得性衰弱认知的质性研究[J]. 护理实践与研究,2016,13(14):9-11.
Wu L,Wang JN.Qualitative research on ICU acquired weakness recognition of ICU nurses[J]. Nurs Pract Res,2016,13(14):9-11.
[23] 陈惠瑶,李杏崧,张莉. 脓毒症患者ICU获得性肌无力早期康复的研究进展[J]. 中华急危重症护理杂志,2022,3(4):326-330.
Chen HY,Li XS,Zhang L.The early rehabilitation of ICU acquired weakness in sepsis patients:a review[J]. Chin J Emerg Crit Care Nurs,2022,3(4):326-330.
[24] 刘晶涛. 基于护理视角的ICU获得性衰弱预防措施落实的阻碍因素研究[D]. 南京:南京大学,2020.
Liu JT.Study on the obstacles to the implementation of preventive measures for acquired weakness in ICU from the perspective of nursing[D]. Nanjing:Nanjing University,2020.