重症监护室连续性肾脏替代治疗患者早期活动方案的构建

doi:10.3761/j.issn.2096-7446.2022.04.004

摘要/Abstract

摘要： 目的构建重症监护室连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）患者早期活动方案。方法检索国内外文献,拟定重症监护室CRRT患者早期活动方案的初稿。2021年8月—10月,运用德尔菲法对25名专家进行2轮咨询,形成重症监护室CRRT患者早期活动方案终稿。结果 2轮专家咨询的有效问卷回收率均为100%,权威系数为0.884,肯德尔协调系数分别为0.069和0.085（P<0.001）。最终形成的重症监护室CRRT患者早期活动方案,包括活动评估、活动计划、活动实施、活动评价4项一级指标、17项二级指标、42项三级指标。结论重症监护室CRRT患者早期活动方案具有一定的科学性、可行性,可为今后临床开展CRRT患者早期活动提供依据。

关键词: 重症监护病房, 连续性肾脏替代治疗, 早期活动, 德尔菲技术, 危重病护理

Abstract: Objective To construct an early mobilization program for patients undergoing continuous renal replacement therapy（CRRT） in intensive care units. Methods A preliminary draft of early mobilization program for CRRT patients in intensive care units was prepared by searching domestic and foreign literatures. From August to October 2021,the Delphi method was applied to conduct two rounds of letter consultation with 25 experts and form the final draft of early mobilization program for CRRT patients in intensive care units. Results The effective questionnaire recovery rate was 100%,the authority coefficient was 0.884,and Kendall's Coordination Coefficient was 0.069 and 0.085（P< 0.01）. The early mobilization program for CRRT patients in intensive care unit was finally formed,including 4 primary indicators,17 secondary indicators and 42 tertiary indicators,including mobilization assessment,planning,implementation and evaluation. Conclusion The early mobilization program for patients with continuous renal replacement therapy in intensive care units developed in this study is scientific and feasible,providing reference for the development of early mobilization for patients with CRRT in the future.

Key words: Intensive Care Units, Continuous Renal Replacement Therapy, Early Mobilization, Delphi Technique, Critical Care Nursing

王海鸥, 李国宏. 重症监护室连续性肾脏替代治疗患者早期活动方案的构建[J]. 中华急危重症护理杂志, 2022, 3(4): 312-319.

WANG Haiou, LI Guohong. The construction of an early mobilization program for patients undergoing continuous renal replacement therapy in intensive care units[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(4): 312-319.

参考文献

[1] Lee Y,Kim K,Lim C,et al.Effects of the ABCDE bundle on the prevention of post-intensive care syndrome:a retrospective study[J]. J Adv Nurs,2020,76(2):588-599.
[2] Parry SM,Puthucheary ZA.The impact of extended bed rest on the musculoskeletal system in the critical care environment[J]. Extrem Physiol Med,2015,4:16.
[3] Wang YT,Haines TP,Ritchie P,et al.Early mobilization on continuous renal replacement therapy is safe and may improve filter life[J]. Crit Care,2014,18(4):R161.
[4] Hickmann CE,Castanares-Zapatero D,Bialais E,et al.Teamwork enables high level of early mobilization in critically ill patients[J]. Ann Intensive Care,2016,6(1):80.
[5] Castro-Avila AC,Serón P,Fan E,et al.Effect of early rehabilitation during intensive care unit stay on functional status:systematic review and meta-analysis[J]. PLoS One,2015,10(7):e0130722.
[6] Hodgson CL,Stiller K,Needham DM,et al.Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults[J]. Crit Care,2014,18(6):658.
[7] Devlin JW,Skrobik Y,Gélinas C,et al.Clinical practice guidelines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. Crit Care Med,2018,46(9):e825-e873.
[8] Ragland C,Ochoa L,Hartjes. Early mobilisation in intensive care during renal replacement therapy:a quality improvement project[J]. Intensive Crit Care Nurs,2019,52:22-27.
[9] 陈丽花,曾丽婷,徐蒙蒙,等. ICU连续性肾脏替代治疗病人早期运动的安全性与可行性研究[J]. 护理研究,2020,34(3):497-499.
Chen LH,Zeng LT,Xu MM,et al.Safety and feasibility of early exercise in ICU patients undergoing continuous renal replacement therapy[J]. Chin Nurs Res,2020,34(3):497-499.
[10] Brouwers MC,Kho ME,Browman GP,et al.AGREE Ⅱ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med,2010,51(5):421-424.
[11] Shea BJ,Reeves BC,Wells G,et al.AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ,2017,358:j4008.
[12] 胡雁. 循证护理学[M]. 北京:人民卫生出版社,2012.
Hu Y.Evidence-based nursing[M]. Beijing:People's Medical Publishing House,2012.
[13] Aquim EE,Bernardo WM,Buzzini RF,et al.Brazilian guidelines for early mobilization in intensive care unit[J]. Rev Bras Ter Intensiva,2019,31(4):434-443.
[14] National Institute for Health and Clinical Excellence. Rehabilitation after critical illness in adults[EB/OL].(2009-03-25)[2019-11-01]. https://www.nice.org.uk/guidance/cg83.
[15] Bein T,Bischoff M,Brückner U,et al.S2e guideline:positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders:revision 2015:S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine(DGAI)[J]. Anaesthesist,2015,64(Suppl 1):1-26.
[16] 王秋雁,边仁秀,戎军,等. 浙江省重症康复专家共识[J]. 浙江医学,2017,39(24):2191-2196,2209.
Wang QY,Bian RX,Rong J,et al.Expert consensus on critical rehabilitation in Zhejiang Province[J]. Zhejiang Med J,2017,39(24):2191-2196,2209.
[17] Gosselink R,Bott J,Johnson M,et al.Physiotherapy for adult patients with critical illness:recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients[J]. Intensive Care Med,2008,34(7):1188-1199.
[18] Sommers J,Engelbert RHH,Dettling-Ihnenfeldt D,et al.Physiotherapy in the intensive care unit:an evidence-based,expert driven,practical statement and rehabilitation recommendations[J]. Clin Rehabil,2015,29(11):1051-1063.
[19] 国家心血管病中心,冠状动脉旁路移植术后心脏康复专家共识编写委员会,冠状动脉旁路移植术后心脏康复专家共识[J]. 中国循环杂志,2020,35(1):4-15.
National Center for Cardiovascular Disease,Expert Consensus Writing Committee on Cardiac Rehabilitation after Coronary Artery Bypass Transplantation. Expert consensus on cardiac rehabilitation after coronary artery bypass transplantation[J]. Chin J Circulation,2020,35(1):4-15.
[20] 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.Consensus of Chinese experts on severe neurological rehabilitation(PART I)[J]. Chin J Rehabil Med,2018,33(1):7-14.
[21] 武亮,郭琪,胡菱,等. 中国呼吸重症康复治疗技术专家共识[J]. 中国老年保健医学,2018,16(5):3-11.
Wu L,Guo Q,Hu L,et al.Expert consensus on severe respiratory rehabilitation in China[J]. Chin J Geriatr Care,2018,16(5):3-11.
[22] Arias-Fernández P,Romero-Martin M,Gómez-Salgado J,et al.Rehabilitation and early mobilization in the critical patient:systematic review[J]. J Phys Ther Sci,2018,30(9):1193-1201.
[23] Mayer KP,Joseph-Isang E,Robinson LE,et al.Safety and feasibility of physical rehabilitation and active mobilization in patients requiring continuous renal replacement therapy:a systematic review[J]. Crit Care Med,2020,48(11):e1112-e1120.
[24] Mayer KP,Hornsby AR,Soriano VO,et al.Safety,feasibility,and efficacy of early rehabilitation in patients requiring continuous renal replacement:a quality improvement study[J]. Kidney Int Rep,2020,5(1):39-47.
[25] Lee H,Ko YJ,Jung J,et al.Monitoring of potential safety events and vital signs during active mobilization of patients undergoing continuous renal replacement therapy in a medical intensive care unit[J]. Blood Purif,2016,42(1):83-90.
[26] Toonstra AL,Zanni JM,Sperati CJ,et al.Feasibility and safety of physical therapy during continuous renal replacement therapy in the intensive care unit[J]. Ann Am Thorac Soc,2016,13(5):699-704.
[27] 黄卓凡,谢静,陈奕冰,等. ICU连续性肾脏替代治疗期间早期活动可行性研究[J]. 齐齐哈尔医学院学报,2020,41(15):1962-1964.
Huang ZF,Xie J,Chen YB,et al.Feasibility study of early activity during continuous renal replacement therapy in ICU[J]. J Qiqihar Med Univ,2020,41(15):1962-1964.
[28] Amidei C.Mobilisation in critical care:a concept analysis[J]. Intensive Crit Care Nurs,2012,28(2):73-81.
[29] 韩汝宁,李秀川,赵士兵,等. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志,2020,55(1):8-15.
Han RN,Li XC,Zhao SB,et al.Construction and application of early rehabilitation scheme for intensive care unit patients[J]. Chin J Nurs,2020,55(1):8-15.
[30] Majid N,Lee SS,Plummer V.The effectiveness of orthopedic patient education in improving patient outcomes:a systematic review protocol[J]. JBI Database System Rev Implement Rep,2015,13(1):122-133.