Application value analysis of individualized restraint management strategy in patients with delirium after cardiac and macrovascular surgery

He Meng; Gu Meiqiu; Xu Bin; Li Xiaomeng; Xu Yajing; Xu Lili; Ren Changwei; Lai Yongqiang

doi:10.3760/j.issn.1673-4777.2026.06.008

Abstract：Objective To explore the application value of individualized restraint management strategy in patients with delirium after cardiac and macrovascular surgery.Methods A total of 90 patients who developed postoperative delirium after cardiac and macrovascular surgery in Beijing Anzhen Hospital,Capital Medical University from July 2023 to March 2024 were retrospectively enrolled.According to the implementation time of management strategies,the patients were divided into pre-improvement group(July to September 2023),ongoing-improvement group(October to December 2023)and post-improvement group(January to March 2024).Based on the physical restraint assessment scale for intensive care unit patients,the individualized restraint management strategy implemented graded restraint and alternative measures combined with psychological counseling,family participation and empowerment.The severity of delirium,average use time of restraints and incidence of adverse events were compared among the three groups.Results A total of 90 patients with delirium after cardiac and macrovascular surgery were enrolled in this study,including 35 cases in the pre-improvement group,27 cases in the ongoing-improvement group and 28 cases in the post-improvement group.The severity of delirium among the three groups showed a significant downward trend with the advancement of management stages(r=-0.51,P＜0.001).The proportion of patients with mild delirium in the post-improvement group was significantly higher than that in the ongoing-improvement group and pre-improvement group,while the proportion of severe delirium was significantly lower than that in the pre-improvement group and ongoing-improvement group(all P＜0.001).The delirium severity score gradually decreased from(21.1±2.3)in the pre-improvement stage to(16.3±2.8)in the ongoing-improvement stage and(8.5±2.2)in the post-improvement stage(P＜0.001).Meanwhile,the average duration of restraint belt application was gradually shortened(P=0.025).The total incidence of adverse events in the three groups presented a gradual downward trend(P=0.144).Conclusions The individualized restraint management strategy can significantly reduce the severity of delirium,shorten the duration of restraint use,and decrease the incidence of adverse events in patients after cardiac and macrovascular surgery.