中华骨与关节外科杂志

目的：构建老年髋部骨折术后谵妄患者的约束分级方案，并探讨其应用效果。方法：通过便利抽样法选取2019年9月至2021年8月北京协和医院收治的57例患者作为常规干预组，2021年9月至2023年8月北京协和医院收治的64例患者作为分级约束组。使用德尔菲专家函询法构建老年髋部骨折术后谵妄患者约束分级方案。记录并比较两组患者的约束率、约束强度、约束相关损伤与不良事件发生情况，以及约束结局。结果：分级约束组患者的约束率低于常规干预组；分级约束组患者Ⅰ级约束次数多于常规干预组，约束时间长于常规干预组；分级约束组患者Ⅲ、Ⅳ级约束次数少于常规干预组，约束时间短于常规干预组，约束肢体未处于功能位、约束部位皮肤损伤、约束肢体血液循环障碍发生率均少于常规干预组，差异均有统计学意义（P均<0.05）。两组患者不良事件发生率比较，差异无统计学意义（P>0.05）。分级约束组患者住院时间短于常规干预组，最高约束等级、出院时约束等级、约束等级改善程度均优于常规干预组；分级约束组患者出院时谵妄评分低于常规干预组，谵妄评分改善程度优于常规干预组，差异均有统计学意义（P均<0.05）。结论：本研究基于德尔菲专家函询法构建老年髋部骨折术后谵妄患者的约束分级方案，并通过临床实践进行验证。通过规范约束工具的使用指征及操作流程，在有效降低患者约束率的同时，保障患者安全，降低不良事件发生率。

Objective: To develop a graded restraint protocol for elderly patients with postoperative delirium following hip fracture surgery and explore its application effects. Method: A total of 57 patients admitted to Peking Union Medical College Hospital from September 2019 to August 2021 were selected as the conventional intervention group, and 64 patients admitted from September 2021 to August 2023 were selected as the graded restraint group using convenient sampling. The Delphi consensus methodology was used to construct a graded restraint protocol for elderly patients with postoperative delirium following hip fracture surgery. The restraint rate,restraint intensity, restraint-related injuries and adverse events, and restraint outcomes were recorded and compared between the two groups. Results: The restraint rate was lower in the graded restraint group than in the conventional intervention group. The number of grade I restraints and restraint duration were higher in the graded restraint group, while the number of grade III and IV restraints and restraint duration were lower in the graded restraint group compared to the conventional intervention group. The incidences of the nonfunctional position of the restraint limbs, skin injuries at restraint sites, and circulatory disorders of the restrained limbs were significantly lower in the graded restraint group than in the conventional intervention group(all P<0.05). There was no significant difference in the incidence of adverse events between the two groups(P>0.05). The graded restraint group had a shorter hospital stay.The highest constraint grade, discharge constraint level, and constraint grade improvement in the graded constraint group were better than in the conventional intervention group. The delirium score was significantly lower at discharge, and the improvement in delirium score was significantly greater in the graded restraint group than in the conventional intervention group(all P<0.05). Conclusion: This study developed a graded restraint protocol for elderly patients with postoperative delirium following hip fracture surgery using the Delphi consensus methodology and validated its application through clinical practice. By standardizing the indications and operational procedures for restraint tools, the protocol effectively reduced the restraint rate while ensuring patient safety and reducing the incidence of adverse events.