重症监护后综合征与出院患者生存率的相关性研究

目的 探索重症监护后综合征(PICS)对ICU患者出院后的生存率的影响。方法 纳入2019年2月-2021年10月在我院ICU病房住院治疗的365例患者。在患者转出ICU当天，采用10m步行测试检测患者身体障碍，迷你智力状态评估量表(Mini-Cog)检测认知功能障碍，两条目患者健康问卷抑郁量表(PHQ-2)检测精神障碍。通过审查病历或电话随访确定患者的生存情况，随访时间为2.5年。研究PICS及其各亚型(身体障碍、认知障碍和精神障碍)与全因死亡率之间的相关性。结果 190例(52.1%)患者被诊断为PICS。26例患者在出院后平均(1.0±0.6)年的随访期间死亡。与无PICS的患者相比，PICS患者的生存率更低(86.14%vs. 97.1%,Log rank P=0.024)。与未发生身体障碍、认知障碍和精神障碍的患者相比，发生身体障碍(82.6%vs.98.8%,Log rank P<0.001)、认知障碍(84.0%vs.99.0%,Log rank P<0.001)的患者2.5年生存率更低，而发生精神障碍的患者生存率差异无统计学意义(94.4%vs.99.3%,...     

全程个性化信息支持护理干预方案对ICU患者综合征及生存质量的影响

目的：探讨全程个性化信息支持护理干预方案对重症监护室(ICU)患者综合征(PICS)及生存质量的影响。方法：将2020年1月1日～2022年1月31日90例ICU患者采用单盲随机分组法均分为观察组和对照组各45例,对照组实施常规ICU护理措施,观察组在对照组基础上实施全程个性化信息支持护理干预方案。比较两组干预前后PICS情况[采用ICU意识模糊评估量表(CAM-ICU)],PICS发生率,生活质量[采用简明健康状况量表(SF-36)]。结果：观察组PICS发生率低于对照组(P<0.05);两组干预后SF-36各维度评分高于干预前(P<0.01),且观察组高于对照组(P<0.01)。结论：全程个性化信息支持护理干预方案可有效降低PICS发生率,改善患者生存质量。     

ICU滞留患者的临床特征及预后分析

目的 探讨ICU滞留患者的临床特征及预后.方法 回顾性分析2018年1月至2019年12月间入住ICU病房滞留时间≥8 d的112例患者.依据慢性危重病(CCI)及持续性炎症-免疫抑制-分解代谢综合征(PICS)诊断标准将所有患者分成4组:PICS组(27例)、CCI组(30例)、PICS合并CCI组(30例)及非PI...     

ICU后综合征概念发展及早期干预措施的研究进展

介绍国内外ICU后综合征(post-intensive care syndrome, PICS)概念框架、PICS概念的最新发展及PICS相关干预措施的研究进展,以期为PICS的随访及病人的管理提供参考。     

ICU患者早期活动的研究进展

ICU救治可降低危重患者的病死率,但由于长时间卧床导致ICU患者肌力快速丧失,出现ICU获得性肌无力,严重影响患者身体功能,降低患者生活质量。众多研究指出ICU患者早期活动可改善ICU获得性肌无力。本文综述了国内外ICU患者早期活动的概念、启动与暂停指征、效果、安全性以及早期活动开展状况与影响因素。     

重症监护后综合征的研究进展

随着医学技术的进步、重症医学科（ICU）的普及、先进监测治疗仪器在临床上的广泛应用，重症医学学科的发展日新月异，得益于此，ICU的转出患者人数与日俱增。然而，由于转出ICU后患者及家属身心健康被忽视等原因，患者会出现生理、认知、心理障碍，这个庞大群体的后续康复状况及生活水平并没有我们想象的那么顺利。在2010年的全球危重症会议上，美国危重症学会提出的新名词概念，"重症监护后综合征（PICS）"引起了世界范围内学者的广泛关注。本综述将从ICU后综合征的概念、临床表现、影响因素、评估工具、干预措施五方面展开，为科研工作者对PICS的学习研究提供参考，为医护人员对PICS的预防治疗扩展思路。     

心血管外科术后患者ICU后综合征风险预测模型的构建及验证

目的 探讨心血管外科术后患者发生ICU后综合征（post-intensive care syndrome,PICS）的危险因素,建立风险预测模型,并进行内部验证检验预测效果。 方法 采用便利抽样法,选取2019年7月—10月在长沙市2所三级甲等医院心血管外科术后转入ICU的304例患者进行调查,并于患者转出ICU后3个月时进行随访,根据随访时患者是否发生PICS分为发生PICS组（n=103）和未发生PICS组（n=201）,筛选PICS的危险因素并根据Logistic回归结果建立预测模型。采用受试者操作特征曲线（receiver operating characteristic curve,ROC）下面积检验模型的预测效果,采用Bootstrap自助法重抽样1 000次对模型进行内部验证。 结果 最终构建的模型为：Logit P=0.722×性别+0.903×年龄+0.968×心理弹性得分+1.073×术前左心室射血分数+0.706×手术时长+0.797×入住ICU时长-3.212。预测模型的ROC下面积为0.817,灵敏度为59.2%,特异度为85.6%。Bootstrap自助法进行内部验证的结果显示,C指数为0.804,提示模型预测效果良好。 结论 该研究构建的心血管外科术后患者PICS风险预测模型预测效能良好,有助于预测PICS的发生,为今后相关干预措施的制订与实施提供了参考依据。     

心理支持联合多学科合作为主导的过渡护理模式在ICU后综合征患者中的应用研究

目的探讨心理支持联合多学科合作为主导的过渡护理模式在预防患者ICU后综合征(PICS)中的应用效果。方法选取2019年7月—2020年2月期间本院外科重症监护病房(ICU)收治的100例危重症患者作为研究对象。根据随机数字表法将患者分为对照组和观察组,每组各50例。对照组给予常规ICU护理干预,观察组给予心理支持联合多学科合作为主导的过渡护理模式干预,并随访2个月。比较两组患者PICS发生率、认知功能、日常生活能力、睡眠情况及焦虑抑郁情况。结果随访期结束,观察组患者PICS发生率低于对照组,差异具有统计学差异(P<0.05)。随访2个月时,两组患者简要精神状态量表(MMSE)评分、Barthel指数均高于转出ICU时,且观察组患者上述评分高于对照组,差异具有统计学差异(P<0.05)。随访2个月时,两组患者匹兹堡睡眠质量指数量表(PSQI)评分、焦虑抑郁量表(HAD)焦虑维度评分、HAD抑郁维度评分均低于转出ICU时,且观察组患者上述评分低于对照组,差异具有统计学差异(P<0.05)。结论心理支持联合多学科合作为主导的过渡护理模式可有效预防患者PICS的发生,同时可促进ICU患者认知状况、生理状况和心理状况的改善。     

ICU护士对患者早期活动的信念和态度现状调查

目的调查ICU护士对患者早期活动的信念和态度及其影响因素。方法采用自行设计的ICU护士对患者早期活动信念及态度调查表,对243名ICU护士进行调查。结果 ICU护士对早期活动的信念得分为(4.03±0.34)分,态度得分为(2.96±0.21)分;回归分析显示,学历、工作年限、具有实施早期活动的经验、定期接受早期活动相关培训是ICU护士对患者实施早期活动信念和态度的影响因素。结论 ICU护士对患者早期活动的认知有待提高,需要不断增强相关知识的培训教育,以促进其信念的转变,提高护士在早期活动中的主动性与积极性。     

ICU护士对患者早期活动认知和行为的调查研究

目的 了解ICU护士对患者早期活动的知识、信念和行为现状,并分析其影响因素,为ICU患者早期活动的开展提供参考。 方法 采用一般资料调查表和ICU护士对患者早期活动的知识、信念和行为问卷对3所综合性三级甲等医院的130名ICU护士进行调查。 结果 ICU护士对患者早期活动的知识得分为（6.80±1.67）分,合格率为55.73%;信念得分为（20.28±2.47）分;行为得分为（15.20±3.19）分。多元线性回归结果显示,年龄及是否为专科护士是ICU护士对患者早期活动的知识、信念的影响因素（P＜0.01）;是否为专科护士是ICU护士对患者早期活动行为的影响因素（P＜0.01）。 结论 ICU护士对患者早期活动的信念较好,知识有待提高,行为一般;下一步应加强ICU护士对患者早期活动知识的学习,提高护理人员对患者早期活动的认知,促进早期活动在临床中开展。     

血浆降钙素原对重症患者预后的预测价值研究

目的：探讨血浆降钙素原（PCT）水平对危重病患者预后评估的临床意义。方法：测定2011年12月至2012年5月331例危重病患者入ICU时的血浆PCT水平,并分析其对人ICU28d预后评估的临床意义。结果：ICU28d生存组PCT水平明显低于死亡组（P〈0．05）,Logistic回归分析显示入ICU时PCT〉0．495ng／ml可作为28d生存状态预测的独立因子（OR2．07,95％CI 1．17-3．68）。结论：入ICU时PCT〉0．495ng／m1可作为重症患者短期生存状态的预测因子。     

层级化管理对ICU重症肺炎患者早期活动效果的影响

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。     

基于4E模式的ICU早期康复方案在机械通气患者中的应用

目的:分析基于4E模式的ICU早期康复方案在机械通气患者中的应用效果。方法:采用便利抽样法,选取某医院2个ICU病区收治的74例患者为研究对象,ICU一区患者为实验组(n=38),ICU二区患者为对照组(n=36)。对照组接受常规康复护理,实验组接受基于4E模式的ICU早期康复方案。结果:两组患者在ICU谵妄发生率、谵妄持续时间、医学研究理事会肌力评分、ICU获得性衰弱(ICU-AW)发生率、机械通气时间、ICU住院时间、总住院时间等方面差异均有统计学意义(P<0.05)。在实施过程中,实验组患者未发生早期康复相关的严重不良事件。结论:对机械通气患者实施基于4E模式的ICU早期康复方案安全可行且有效,可改善患者肌力,降低ICU-AW及ICU谵妄发生率,缩短ICU谵妄持续时间、机械通气时间、ICU住院时间与总住院时间。     

Accuracy of predictions of survival at admission to the intensive care unit

PURPOSE: The purpose of this study was to compare the accuracy of outcome predictions made on the day of intensive care unit (ICU) admission by critical care physicians, critical care fellows, and primary team physicians. PATIENTS AND METHODS: Fifty-nine consecutive patients admitted to a Medical-Surgical ICU were included in the study.Two ICU attending physicians and two critical care fellows, not involved in medical management, evaluated each new ICU patient at admission and after 48 to 72 hours. Altogether six ICU attendings and six fellows were involved in the study. Each investigator separately assigned probability to each patient of being discharged alive from the ICU and the hospital. On the day of admission the primary service was also asked to estimate the likelihood of successful outcome. All values are expressed in percentiles. Statistical analysis was performed by a logistic regression procedure with a binary outcome. Data are presented as mean +/- SD. RESULTS: Fifty-nine patients were surveyed. Twenty-six (44%) patients died in the ICU, 3 (5%) died in the hospital wards, and 30 (51%) were discharged alive from the hospital. ICU attendings most reliably and accurately estimated patient outcome on admission compared with critical care fellows and primary team physicians. ICU attendings were more consistent than ICU fellows at predicting outcome at 48 and 72 hours. Clinical predictions were better for patients at the extremes of disease severity, and the accuracy of predictions in these patients was highest. Accuracy was diminished in patients with moderate compromise of clinical status. CONCLUSION: ICU attendings predicted most accurately and consistently the final outcome of patients, and ICU fellows estimated outcome more reliably than the primary service. For the most part, the primary service tended to overestimate the probability of favorable outcome of patients for whom ICU admission had been requested. Additionally, clinical accuracy of survival or mortality was best for those patients at the extremes of clinical compromise: this point seems to confirm the validity of using clinical judgement as a guide to restricting ICU resources for those severely compromised or mildly compromised.This study also indicates that predictions of outcome in critically ill patients made within days of admission are statistically valid but not sufficiently reliable to justify irrevocable clinical decisions at present.     

Effects of early physiotherapy with respect to severity of pneumonia of elderly patients admitted to an intensive care unit: a single center study in Japan

[Purpose] We performed early physiotherapy for elderly patients with pneumonia admitted to an intensive care unit (ICU), and examined the effects of this early physiotherapy on the severity of pneumonia. [Subjects and Methods] Patients for whom physiotherapy was started the day after admission to the ICU (acute phase) were assigned to the early intervention group and compared with patients in the standard intervention group. All patients were divided into three groups (Groups I, II, and III) based on the severity of pneumonia. We evaluated the ICU admission period, hospitalization period, and activities of daily living (ADL) before and after admission. [Results] With respect to the severity of pneumonia, Group II showed significant differences in the ICU admission period and rates of change in the operating range, cognitive domain, and Functional Independence Measure (FIM). Group III showed significant differences in the ICU admission period and rate of change in the cognitive domain (FIM item). The results were more favorable in the early intervention group than in the standard intervention group. [Conclusion] The ICU admission period was shorter and a reduction in the ADL level was prevented in Groups II, and III compared to Group I. This may have occurred because of the early rehabilitation.Key words: Pneumonia, Early physiotherapy, Intensive care unit     

早期程序化活动在ICU患者中的应用

目的探讨早期程序化活动在ICU患者中的护理效果。方法选择2012年3—6月入住ICU的患者50例,根据随机数字表法分为活动组及对照组,每组25例。对照组患者给予常规护理,活动组患者实施早期程序化活动管理,比较两组患者的呼吸机通气时间、监护室住院时间、总住院时间等指标。结果活动组患者的呼吸机通气时间为（2．4±0．3）d,低于对照组的（3．2±0．5）d,差异有统计学意义（t=5．182,P〈0．05）;活动组患者的监护室住院时间、总住院时间分别为[（5．2±0．3）,（9．6±1．4）]d,对照组为[（5．8±0．3）,（8．8±1．2）d],差异无统计学意义（t值分别为1．013,2．674;P〉0．05）;活动组患者监护室死亡率为8．0％,住院期间死亡率为8．0％,对照组为12．0％,16．0％,差异无统计学意义（x2值分别为3．873,4．347;P〉0．05）。结论早期程序化活动对减少呼吸机通气时间,减少远期并发症,提高患者的生活质量至关重要。     

Patient severity as an indicator of nursing workload in the intensive care unit

The importance of measuring nursing workload in the intensive care unit (ICU) has been supported by both an increasing demand for nursing personnel and the relationship of nursing workload with patient safety. According to previous studies, the correlation between clinical severity of ICU patients and nursing workload measured by Therapeutic Intervention Scoring System has been estimated to be particularly high. The aim of this study was to investigate whether clinical severity of ICU patients can be used for the prediction of nursing workload on a daily basis. All patients admitted in the ICU of the General University Hospital of Patras for a 5-month period were enrolled in the study. Projet de Recherche en Nursing (PRN) Réa and Acute Physiology and Chronic Health Evaluation (APACHE) II scores of patients were calculated, the first on a daily basis and the second on the day of admission. Simple linear regression was used for statistical analysis of data. One hundred thirty-eight patients were studied. A progressive increase in mean daily PRN Réa of patients all along the amplitude of APACHE II values was shown. APACHE II could predict 25.6% (p < 0.01) of the daily variability of PRN Réa of patients. Regarding categories of PRN Réa, respiration, communication, diagnostic methods and treatments were significantly predicted by APACHE II. APACHE II explained higher proportions of PRN Réa in medical male patients aged >60 years. Clinical severity of the ICU patients measured by APACHE II is an important early indicator of daily nursing workload, especially of care demands associated with respiration, diagnostic methods and treatments.     

Intensive care unit: how stressful for physicians?

The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians' ratings of stress in the ICU to other medical-surgical rotations. The 26 physicians in this study rated the ICU significantly less negatively than other rotations. There was also a trend to rate the ICU more positively. Prolonged care of patients with multisystem failure and a poor prognosis was the most frequently described source of stress. Humor, communication, and activities outside the ICU were the most frequently noted coping techniques.     

Readmission to intensive care: a review of the literature.

Acutely ill patients are commonly found on general hospital wards; some of these are patients who have been recently discharged from an intensive care unit (ICU). These patients may require a higher level of care than other ward patients and, due to the acuity of their illness, are at risk of readmission to ICU. Research has indicated that patients readmitted to ICU have mortality rates up to six times higher than those not readmitted and are eleven times more likely to die in hospital. Numerous studies have retrospectively examined these readmissions but, despite this, there is still no clear indication of why ICU readmissions occur or what the common characteristics of readmitted patients are. This literature review examines the published studies on patients who have been readmitted to ICU. Further research is needed to explore why readmissions to ICU occur and the type of patient who is at greatest risk for readmission.