摘要目的:探讨层级化管理对重症监护病房(ICU)重症肺炎患者早期活动效果的影响。方法:选取2017年6月至2018年5月广东省农垦中心医院收治的100例ICU重症肺炎患者，根据患者住院病床单双号分为观察组和对照组，各50例。对照组采用常规方法每日主观判断患者活动能力并进行常规活动；观察组根据影响ICU重症肺炎患者早期活动的因素对ICU患者的活动能力进行A、B、C、D层级划分，并制定相应层级的活动方案，通过每日评估患者所属的层级，进而采取相应的活动方案进行活动。应用巴氏指数评分表(Barthel指数)进行评分，以判断日常生活的活动能力，并比较两组差异。同时，比较两组患者呼吸机使用时间、出科时的血氧饱和度、ICU平均住院时间、患者对护理工作的满意度。结果:两组患者入科时Barthel指数得分比较差异无统计学意义( P>0.05)；两组患者出科时的Barthel指数得分与入科时比较，差异有统计学意义( P<0.05)；观察组患者呼吸机使用时间和ICU平均住院时间明显短于对照组，出科时血氧饱和度明显优于对照组，护理工作满意度明显高于对照组，差异均有统计学意义( P<0.05)。 结论:实施层级化管理进一步提升ICU重症肺炎患者的日常生活能力，加快患者的康复进程，提高患者的治疗效果和护理满意度。

abstractsObjective:To explore the effect of hierarchical management on the early activity of severe pneumonia patients in intensive care unit (ICU).Methods:A total of 100 patients with severe pneumonia in ICU admitted to Guangdong Agricultural Cultivation Central Hospital from June 2017 to May 2018 were selected. The patients were divided into observation group and control group with 50 patients in each group according to the odd and even number of inpatient beds.The control group used routine methods to judge the patients' activity ability and perform routine activities on a daily basis.The observation group divided the activity ability of ICU patients into levels A, B, C, and D according to the factors affecting the early activities of ICU patients with severe pneumonia, and developed the corresponding level of activity programs. By daily assessment of the level of patients, the corresponding activity programs were adopted for activities.The Barthel index was used to judge the activity ability of daily life, and the differences between the two groups were compared.Meanwhile, the use time of ventilator, blood oxygen saturation at the time of discharge, average length of stay in ICU, and patients' satisfaction with nursing work were compared between the two groups.Results:There was no significant difference in Barthel index score between the two groups( P>0.05). There was a statistically significant difference between the Barthel index score at the time of discharge and that at the time of admission( P<0.05). The duration of ventilator use and average length of stay in ICU in the observation group were significantly shorter than those in the control group, blood oxygen saturation was significantly better than that in the control group, and nursing work satisfaction was significantly higher than that in the control group, with statistically significant differences( P<0.05). Conclusions:The implementation of hierarchical management can further improve the daily living ability of ICU patients with severe pneumonia, accelerate the recovery process of patients, and improve the treatment effect and nursing satisfaction of patients.