重症监护病房患者不适体验及影响因素的临床调查研究

Discomfort experience and influencing factors of patients in intensive care unit

摘要:

目的了解危重患者在重症监护病房(ICU)住院期间疼痛、焦虑、睡眠障碍等不适体验发生的比例及严重程度,探讨治疗干预手段、护理操作和病房环境等对患者不适体验的影响。方法2006年6月至2007年12月收住东南大学附属中大医院ICU,且ICU住院时间超过24h的危重患者,患者经积极抢救治疗后病情相对平稳,转至普通病房。转科后3～7d内接受问卷调查。记录患者疼痛、焦虑、口渴、睡眠障碍和自觉环境噪音等不适体验的发生率,分析导致患者不适体验的影响因素。结果142名ICU危重患者纳入观察组,患者疼痛、焦虑、口渴、睡眠障碍和自觉环境噪音等不适的发生率分别为35.2%、51.9%、88.9%、55.8%和47.2%。有78.0%(78/100)的患者可回忆起使用呼吸机的痛苦经历,其中有吸痰痛苦记忆的患者占52.5%(42/80)。吸痰、留置胃管和静脉注射等操作与患者疼痛密切相关;与患者焦虑明显有关的因素有环境噪音、交流困难、机械通气和静脉注射;ICU环境噪音、希望家属陪护、机械通气、经人工气道吸痰、留置胃管及静脉注射等均可能影响患者睡眠,甚至睡眠剥夺。结论ICU患者疼痛、焦虑、睡眠障碍等不适体验发生率高,治疗干预、护理操作及病房环境是导致不适体验发生的主要原因。

Abstract:

Objective To investigate the incidence and severity of discomforts experience,such as pain,anxiety and sleep deprivation in patients in the intensive care unit(ICU),in order to explore the relationship between the discomfort experience and therapeutic measures,nursing procedure and the environment of ICU.Methods A total of 142 critically ill patients,who stayed in ICU for>24 h between Jun 2006 and Dec 2007 were included in the analysis.All patients were interviewed 3 to 7 days after discharging from ICU.The incidence of discomfort experience such as pain,anxiety,thirst,sleep deprivation and subjective feeling of noise were recorded.The factors that influenced the discomfort experience were analysed.Results The incidences of pain,anxiety,thirst,sleep deprivation and subjective feeling of noise were 35.2%,51.9%,88.9%,55.8% and 47.2%,respectively in all these patients.The painful experience of using mechanical ventilation was recalled by 78.0% of the patients.Airway suctioning was experienced as discomfort by 52.5% of the patients.Pain was closely related to airway suctioning,intravenous injection and indwelling gastric tube.The anxiety was intimately related to the environmental noise,intravenous injection and mechanical ventilation.Sleep deprivation was caused by noise,mechanical ventilation,airway suctioning,indwelling gastric tube and intravenous injection,etc.Conclusion The incidence of discomfort experience in critically ill patients is high.Therapeutic intervention,nursing procedure and the environmental noise are the main causes of patients’ experience of discomforts.