目的 基于人文关怀模式，将神经重症患者阶梯式身体约束最佳证据应用于临床，并进行效果评价。 方法 筛选神经重症患者阶梯式身体约束的最佳证据，制订循证护理实践方法，进行基线审查以及障碍因素分析，构建最佳应用策略，融入人文关怀理念，制订阶梯式身体约束方案。在江苏省某三级甲等医院神经外科ICU实施，比较证据应用前后各项审查指标的执行率、患者身体约束时长以及相关并发症发生率。 结果 证据应用前后26项审查指标的执行情况差异均具有统计学意义；两组患者身体约束率、总约束时长、一二级约束时长及因约束导致的负性体验，差异均具有统计学意义（P<0.05）；约束减少后，未发生非计划性拔管。 结论 应用神经重症患者阶梯式身体约束的最佳证据有利于缩短患者身体约束时间、降低身体约束率，保障患者安全。

Objective To apply the best evidence of stepwise physical restraint protocol for critically ill neurological patients in clinical practice，guided by a humanistic care model，and to evaluate its effectiveness. Methods The best evidence regarding stepwise physical restraint for critically ill neurological patients was systematically reviewed. Evidence-based nursing protocols were developed，baseline assessments were conducted to identify potential barriers，and a best implementation strategy was formulated. A stepwise physical restraint program incorporating the principles of humanistic care was designed. This program was implemented in the neurosurgical intensive care unit（ICU） of a Class Ⅲ Grade A hospital in Jiangsu Province. The compliance rates of various audit indicators，the duration of physical restraint，and the incidence of related complications were compared before and after the implementation of the evidence. Results There were statistically significant improvements in the implementation of 26 indicators following the application of the evidence. Statistically significant differences were observed in the physical restraint rate，total restraint time，first and second restraint durations，and negative patient experiences associated with restraint between the two groups（P<0.05）. The reduction in physical restraint did not lead to an increase in unplanned extubation. Conclusion The application of best evidence of stepwise physical restraint for critically ill neurological patients can effectively shorten restraint duration，reduce restraint rates，and ensure patient safety.