2020-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/699557摘要：『坐到站』是離床的第一步，也是行走及獨立日常活動的開始。許多加護病房存活病人，會因無法維持穩定坐姿、下肢肌力不足、身體虛弱害怕跌倒、或因自身及照顧者缺乏移位及安全下床技巧，在轉出後仍多臥床。2019年研究顯示，加護病房存活病人返家後仍有31%的病人活動受限床鋪，即便在他人協助下亦無法『坐到站』。其他研究也顯示一旦是重症系統性乏力者，轉出後一個月無法『坐到站』比率可達70%。本計畫旨於發展並測試一安全有效的加護病房存活病人『坐到站』床邊護理介入措施 (Sit-to-Stand Care, STS Care)。研究將採嚴謹的分層隨機臨床試驗，用連續取樣 (consecutive sampling)以六間內科加護病房為起始點，所有成功轉出加護病房，但無法自己『坐到站』的成年病人，在研究護理師說明並簽署同意書後，先以病人「能否維持穩定坐姿」來分層，再隨機分配至實驗組或常規照護組；實驗組將提供每日一次、為期14天的STS Care，來測試此STS Care是否提高加護病房存活病人『坐到站』能力，並改善轉出加護病房一年內的生理活動功能，和臥床率及死亡率。研究也將檢視病人有無重症系統性乏力及其營養攝食不足程度是否影響STS Care成效。初步規劃的STS Care包含病人轉出加護病房後『坐到站』功能性肌力運動、重複『坐到站』練習、以及『坐到站』的護理指導（示範運用輔具、教導病人及家屬協助下的轉位起身、離床技巧等）。計畫將分三年進行，依據檢力分析，預計收案206位並以轉出加護病房48小時內、14天、1月、3月、12月5個時間點來評估追蹤。研究假設為：相較於接受常規照護的加護病房存活病人，接受STS Care者，在轉出後，自己『坐到站』的百分比較高、30秒『坐到站』次數較多、生理活動功能【加護病房病人功能狀態量表得分、四肢肌肉力量等級及下肢伸膝肌力、ADL/IADL分數及6分鐘行走距離】較佳、且臥床率及死亡率也較低。所得資料將以REDCap系統輸入管理並以SPSS 24版統計軟體進行描述性及推論性分析，以清楚描繪『坐到站』護理介入措施 (STS Care)是否改善加護病房存活病患的『坐到站』能力及轉出一年後的生理活動功能和臥床率及死亡率。這是第一個針對加護病房存活病人『坐到站』的隨機臨床試驗，所得結果將有助於優化臨床照顧、降低無法『坐到站』的病人其個人、家庭及社會成本。<br> Abstract: “Sit-to-stand” is key to independent living. For intensive care unit (ICU) survivors, failure to perform sit-to-stand results in bed-bound status, unable participating in important activities of daily living (ADLs) or instrumental ADLs. Recent studies indicated that 31% of ICU survivors remained bed-bound and unable to “sit-to-stand” after returning home. Our preliminary findings further indicated that 70% of ICU survivors who had the ICU-acquired weakness (ICU-AW) were unable to “sit-to-stand” one-month after ICU discharge. The aim of this 3-year research project is to develop a feasible and effective “sit-to-stand” care (STS Care). A randomized controlled trial (RCT) design is proposed to examine effects of the STS Care in improving ICU patients’ “sit-to-stand” ability, physical function, and rates of bed-bound and mortality one year following ICU discharge. The trial will be registered at the Clinical Trials Registry and approved by the Human Research Ethics Committee at the study site before enrollment. Adult ICU patients (≥ 20 years) admitted consecutively to six medical ICUs of a university-affiliated medical center will be eligible for the study if they were unable to “sit-to-stand” independently at ICU discharge. Upon signing informed consent, participants will be first stratified by “able to remain sitting upright without falling” or “unable to remain sitting upright” and then randomized separately into the intervention or usual care groups, according to computer-generated randomization tables. Participants in the intervention group received both usual care and the STS Care. The hospital-based (up to 14 days) STS Care, which will be provided daily by the same trained nurse, consisted of nurse-supervised anti-gravity and resistant exercise (intensity based on patients’ tolerance), repetitive sit-to-stand practice, and advice on sit-to-stand strategies. All participants’ sit-to-stand ability, physical function (functional status score for the ICU; muscle power levels at 12 muscle groups; muscle strength at knee extensors; ADL/IADL; 6-min walking distance), and rates of bed-bound and mortality will be assessed by two blinded research nurses, at 14-day, 1, 3, and 12 months after ICU discharge.Based on power analysis, 206 participants will be enrolled and followed for one year after ICU discharge. Data will be entered and monitored by the REDCap and analyzed by the SPSS statistics package. This will be the first RCT study to develop a “sit-to-stand” nursing intervention for the ICU survivors who just transferred to the general wards.『坐到站』重症加護病房功能下降加護病房存活病人護理介入臨床隨機試驗Sit-to-standFunctional declineIntensive care unitNursing interventionRandomized controlled trial