关键词: ICU；置管患者； 最佳证据；循证实践

Abstract: Objective: To establish the best evidence of reasonable physical restraint in adults with ICU, and to establish a reasonable physical restraint procedure for adult patients with ICU and evaluate its application. Methods: The systematic search and quality evaluation of the subjects related to the reasonable physical constraints of ICU adult patients were summarized. The best evidences were summarized. Combined with clinical scenarios and professional judgments, 18 evidence-based quality review standards were formulated. The hospital's 1 comprehensive ICU and 5 specialist ICUs were randomly divided into the control group and the implementation group for quality review. Results: There was no significant difference in the rate of restraint and duration of restraint (Days/Thousands of Catheterization) between the two groups (P>0.05) before the edvience applied. After the evidence was applied, the implementation group had lower constraint rate and shorter constraint time (Day/Thousand Tubes Day) than the control group. The difference was statistically significant (P<0.05); the rate of compliance of the analgesic in the implementation group was higher than that before application, the difference was statistically significant (P<0.05). There was no significant difference of the sedation rate and the delirium incidence between the two groups (P>0.05). The degree of anxiety in the implementation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the negative psychological reaction between the family members (P>0.05). The knowledge of the best evidence-related knowledge of doctors and nurses was higher than that before application, and the difference was statistically significant (P<0.05). The implementation of the constrained medical advice the use of the constraint assessment tool, and the signing rate of patient or family consent informed consent form was 100% of the implementation group while the control group still has not issued a doctor's advice, the use of the constraint assessment tool, and the signing of the informed consent form of the patient or family is 100%. There was no significant change in the utilization rate of restraints, the incidence of restrained complications, the incidence of unplanned extubation, and the environmental management of the ICU ward between the two groups. Conclusion: The best evidence for reasonable physical restraint in adult patients with ICU can reduce the restraint rate of adults patients in ICU, shorten the duration of restraint, improve the rate of analgesia, improve the mastery of knowledge of doctors and nurses, and promote the standardization of medical orders and the use of restraint assessment tools to improve the quality of clinical care.

Key words: ICU; catheterized patients; best evidence; evidence-based practice