重症监护室患者不适体验及其与事实记忆的关系

目的 探讨重症监护室(intensive care unit,ICU)患者不适体验及其与事实记忆(factual recollection,FR)的相关性.方法 对55例ICU患者及63例普通病房患者进行标准化FR问卷调查,并对结果进行分析. 结果 64%的ICU转出患者有ICU不适体验,其中以气管内导管、疼痛及幻觉所引起的不适较为常见;ICU患者FR评分平均为7.25分,普通病房患者FR评分平均为13.50分,二者此较差异有统计学意义(t=3.34,P<0.01);Logistic回归分析表明,FR评分与ICU患者不适体验,尤其是与气管内导管、疼痛及幻觉所引起的不适的发生显著相关,OR95%CI(1.2～2.1),P<0.01. 结论 ICU患者的不适体验主要来自于气管内导管、疼痛和幻觉等;ICU患者相对于普通病房患者可能存在记忆减退;FR可能与ICU不适体验的发生具有相关性.     

ICU患者的事实记忆与健康相关生活质量的关系研究

目的 探讨重症监护室患者的事实记忆情况及其与健康相关生活质量的相关性.方法 选择患者116例,在其从外科ICU转出3 d内,采用标准化事实记忆问卷进行调查;在从ICU转出5个月时,采用中文版医学结局研究简明健康状况调查量表进行调查,分析2个量表得分之间的相关程度.结果 (1)男性患者事实记忆评分为(7.25±2.11)分,女性患者为(5.15±2.32)分,男性患者高于女性患者(P<0.05);(2)女性患者健康相关生活质量明显较男性患者差(P<0.05),且主要表现在心理健康方面;有关生理健康,女性患者在躯体疼痛方面差于男性患者(P<0.05);(3)相关分析表明,ICU患者事实记忆与健康相关生活质量呈正相关(r=0.297,P<0.05).结论 术后ICU女性患者较男性患者事实记忆差;转出ICU 5个月时,女性患者的健康相关生活质量较男性患者差,主要表现在心理健康方面;外科ICU患者事实记忆情况可能明显影响其健康相关生活质量.     

胸外科术后监护室患者不适状态的调查及分析

目的 调查胸外科术后重症监护室（Intensive Care Unit,ICU）患者不适状态及其对患者日常生活的影响。方法 选取我院2014年5月到2015年5月入住ICU时间≥24h 的220例ICU住院患者,采用自制不适状态问卷展开调查,并对结果进行分析。结果 ICU患者不适发生比例最为频繁的症状依次是疼痛、疲乏、恶心呕吐、口干、咳嗽等,发生率在52.27%以上。不适强度最为显著的症状依次是疼痛、焦虑、活动受限、咳嗽、疲乏、希望陪护等,强度在中度及以上水平,其中以疼痛最为显著。结论 患者入住ICU期间不适体验发生频率高、程度重,存在较多不适,严重影响患者的生活质量。护士应及时准确地对患者的不适进行评估,积极对不适进行管理与控制,以改善患者的生活质量。     

重症监护室患者服的设计与应用

重症监护室（ICU）是抢救急危重患者生命的重要场所。由于患者病情危重,生活不能自理传统的重症监护室患者服和其它病房患者服相同。即上衣、下裤。在日常工作中,重症患者的穿脱衣服、大小便、冲洗等生活护理工作有很多不便。为此,我们研制了一种重症监护室患者服,取代传统的上衣、下裤各病室一致的患者服,以便于重症监护室患者穿、脱、排便、清洗及医生、护士观察、治疗和护理。现介绍如下。     

重症监护室患者的不适体验对患者健康相关生存质量的影响

重症监护室（intensive care unit,ICU）患者因病情危重,患者的日常活动受到很大的限制,患者在ICU期间仍可能伴有明显的不适体验,且大多为不愉快的负性体验。主要来自于焦虑、疼痛、口唇发干、失眠：失定向、呼吸困难、丧失活动能力、医疗行为及气管内导管等。有研究提示,气管内吸引术所产生的不适对患者影响尤为明显。本研究旨在通过随访调查,阐述ICU患者的不适体验对患者健康相关生存质量（heahhrelated quality of life,HRQOL）的影响,现报道如下。     

重症监护室患者尊严现状及其相关因素调查

目的调查重症监护室患者尊严的现状,并分析其相关因素。方法选取120例重症监护室患者,应用患者尊严量表进行调查。结果患者尊严量表总分为(72.88±18.00)分,患者尊严丧失普遍存在,其中,轻度尊严丧失占14.17%,中度尊严丧失占43.33%,重度尊严丧失占38.33%,非常严重尊严丧失占4.17%。患者年龄与患者尊严总分呈正相关(P0.05);主要照顾者的健康状况、家庭和睦状况是患者尊严丧失的重要影响因素。结论重症监护室患者尊严状况较差,普遍存在尊严丧失,提示应采取有效措施,提高患者的尊严水平。     

重症监护室患者深部真菌感染临床分析

目的 探讨重症病房患者深部真菌感染的临床特点,以利早期防治真菌感染的发生.方法 回顾性分析45例真菌感染患者的临床资料.结果 深部真菌感染的发病率为10.8%(45/415),老年患者发病率高,菌种分布以白色念珠菌最多,真菌感染的发生与长期应用广谱抗菌药物、侵入性操作、使用激素以及糖尿病密切相关.结论 应注意消除诱发因素,早期防治真菌感染的发生.     

重症监护室患者家属需求的研究进展

国内外研究证明,重症监护室（intensive care unit,ICU）的管理模式与护士的角色对家属要求的满足有着重要的影响。参阅近年相关文献,就重危患者家属需求量表的研发和使用、ICU管理模式、ICU护士角色．ICU家属需求研究意义等方面的进展进行综述。     

肿瘤患者手术后重症监护室不适感体验的质性研究

目的探讨肿瘤患者手术后在重症监护室不适感体验及相关影响因素。方法采用质性研究的方法,应用立意取样法,选取2015年1—6月收治于复旦大学附属肿瘤医院重症监护室ICU的患者10例,进行深入访谈,采用质性内容分析法,归纳出患者不适感体验的主题。结果恐惧笼罩着患者内心,焦虑是患者入住ICU不适感的主要来源,生理上的不适严重困扰着患者。结论应用多元整体护理可在改善环境、心理护理、减轻患者生理不适等多方面缓解肿瘤患者术后在ICU的不适感体验。     

Discomfort and factual recollection in intensive care unit patients

Introduction

A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection?

Methods

All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire.

Results

A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min–max) score for factual recollection in the ICU patients was 15 (0–28). The median (min–max) score for factual recollection in the reference group was 25 (19–28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients.

Conclusion

Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort.

     

The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

BackgroundPerson-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined.ObjectivesThe aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients.MethodsThis study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression.ResultsPerson-centred care was associated with ‘awareness of surroundings’ (β = 0.29, p < .001), ‘frightening experiences’ (β = ?0.31, p < .001), and ‘satisfaction with care’ (β = 0.54, p < .001). However, there was no significant association between person-centred care and ‘recall of experience’.ConclusionsWe observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.     

监护病房中高血钠发生的危险因素及护理对策

目的 分析监护病房中高血钠发生的危险因素及护理对策。方法 用急性生理功能与慢性健康状况评分Ⅱ评分系统评估疾病严重程度，采用单因素x^2检验和多因素Logistic回归分析判定发生高血钠的危险因素。结果 监护病房中高血钠患者的发生率为16．55％，高血钠发生与患者不同程度的意识水平，尿量，高热，基础疾病较严重，经口饮水受限及使用脱水剂不当等因素显著相关。结论 高血钠是监护病房中常见并发症，应重视其危险因素，加强护理，减少发生率。     

The lived experience of delirium in intensive care unit patients: A meta-ethnography

ObjectivesThe objectives were to interpretatively synthesise qualitative findings on patients' lived experience of delirium in the intensive care unit (ICU) and to identify meanings and potential existential issues that affect them during and after their experience. Patients may face existential challenges when they are vulnerable in their confusion, all while confronting the reality of their mortality in the critically ill state.Review methodsThe study involved meta-ethnographic synthesis of published qualitative studies addressing the lived experience of delirium for patients in ICU based on a systematic literature search.Data sourcesMEDLINE, PsycINFO, Embase, Scopus, CINAHL, ProQuest, and Cochrane were the sources. Studies were selected based on the predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on a Critical Appraisal Skills Programme tool.ResultsBased on the eligibility criteria, nine qualitative studies were included, of overall medium to high quality. One core theme, “a perturbing altered reality” and four main themes were identified: “disturbed sense of time”, “omnipresent feeling of fear”, “impact of human connection”, and “perceiving surreal events”. These four themes illustrate how the three salient existential issues of uncertainty, self-perceived helplessness, and death that are present in delirium make it a highly distressing experience for patients in ICU.ConclusionsCritically ill patients who experience delirium appear to face intense existential issues, which may not be identified by care providers and may remain unaddressed during their ICU stay and after discharge. Patients report that addressing the memories of these issues would be therapeutic. Future research needs to explore care approaches to meet the unique psychosocial needs of critically ill patients with delirium.     

重症监护室护士眼部护理知识掌握与实践状况分析

目的调查重症监护室（ICU）护士眼部护理知识掌握情况及其眼部护理实践状况。方法自行设计ICU患者眼部护理知识调查表和ICU患者眼部护理实践调查表对上海市3所三级甲等医院145名相关ICU护士进行问卷调查。结果按百分制计算,ICU护士眼部护理知识的总得分为65．66±5.0,引发眼部并发症的危险因素得分为91.5±9．5,眼部护理不当可能导致的并发症的认知为37．0±5.2;知识的掌握与其在ICU工作年限呈正相关。在护理实践方面,分别有80．7％和88.3％的护士表示能做到评估和清洁眼部,100％的护士表示对眼睑闭合不全采用了必要的干预。结论应对相关专业人员进行重症患者眼部护理知识的教育以有效防治ICU患者眼部并发症。     

重症监护病房患者低磷血症的发生及对预后的影响

目的 调查重症监护病房(ICU)患者低磷血症的发生情况,研究不同血磷水平对患者预后的影响.方法 观察2010年4月至11月入住盛京医院ICU 147例患者的血磷水平及低磷血症的发生率,比较轻、中、重度血磷水平患者间急性生理学与慢性健康状况评分系统Ⅱ( APACHEⅡ)评分、住ICU时间、主要实验室指标以及病死率的差异;比较生存和死亡患者住ICU期间血磷的变化.建立血磷水平与是否存活患者之间的受试者工作特征曲线(ROC曲线),探讨血磷水平对预测患者预后的意义.结果 77.6％的患者在入住ICU期间出现低磷,轻度21例、中度70例、重度23例,其中63.3％的患者出现中至重度的低磷;显著低磷的患者不仅APACHEⅡ评分(分)较高(轻度18.2±6.0,中度21.4±7.6,重度25.6±8.8,正常18.9±8.8),呼吸机使用时间(d)延长(轻度6.6±5.1,中度11.3±9.5,重度15.7±10.4,正常6.7±5.9),住ICU时间(d)较长(轻度9.7±6.4,中度10.6±8.2,重度18.9±13.1,正常9.9±7.1),而且病死率随之升高(轻度14.3％,中度25.7％,重度39.1％,正常9.1％).ICU患者的总病死率(22.4％)与低磷的程度呈显著负相关(r=-0.225,P=0.01);血磷＜0.40 mmol/L时预测患者存活的敏感性为78.6％,特异性为51.5％,提示预后较差.结论 大部分ICU患者血磷处于相对较低的水平.ICU患者容易合并低磷血症,重度低磷提示ICU患者预后较差.     

右美托咪定对重症监护病房患者镇痛效果的评价

目的探讨右美托咪定（DEX）对重症监护病房（ICU）患者的镇痛效果。方法选择2011年10月至2012年10月北京积水潭医院ICU收治患者40例，按随机原则分为两组，每组20例。DEX组给予右美托咪定镇痛，芬太尼组给予芬太尼镇痛。于用药前及用药后4、8及12 h用视觉模拟法（VAS）评估疼痛状况，并计算12 h镇痛指数。记录两组患者用药前及用药后4、8及12 h血压、心率（HR）、呼吸频率（RR）、动脉血氧饱和度（SaO2）的变化以及不良反应情况。结果随着用药时间的延长，两组用药后各时间点VAS、血压、HR、RR、SaO2均较用药前降低（均P＜0.05），两组间VAS、血压、HR比较差异均无统计学意义（均P＞0.05），芬太尼组用药后12 h RR（次/min）及SaO2的下降程度较DEX组更明显，差异有统计学意义（RR：13.8±2.0比19.9±1.7，SaO2：0.957±0.015比0.992±0.006，均P＜0.05）。两组镇痛有效率均＞80%。两组均无明显不良反应发生。结论右美托咪定可用于独立镇痛，较芬太尼对呼吸影响小。     

综合重症监护病房医院感染分析

目的了解本院综合ICU医院感染的现状,为医院感染监测与控制提供依据。方法采用前瞻性与回顾性调查相结合的方法,以我国卫生部2001年颁布的《医院感染诊断标准(试行)》进行判定分析。结果共调查329例住院病例,其中感染病例47例(77例次),感染率14.29%(例次感染率23.40%),感染部位以呼吸道为主,其次为泌尿道。感染的危险因素主要为泌尿插管、中心静脉插管和应用人工呼吸机,医院感染病例的病原菌分布以革兰氏阴性杆菌为主。结论 ICU医院感染是多因素共同作用的结果,切实做好医院感染监测和控制,对提高医疗质量,保障医疗、医患安全均具有重要意义。     

人性化综合护理措施对重症监护室患者恢复的影响

目的:探讨人性化综合护理措施对普外科重症监护室患者恢复的影响.方法:将2011年1月～2012年1月我院普外科重症监护室收治的100例患者作为对照组,给予常规护理;将2012年2～10月我院普外科重症监护室收治的77例患者作为研究组,在常规护理的基础上给予人性化综合护理措施.对比分析两组患者的住院时间、抢救成功率、焦虑情绪及对护理工作的满意度.结果:研究组患者的住院时间短于对照组(P＜0.05),抢救成功率高于对照组(P＜0.05),人住重症监护室第15 d焦虑得分低于对照组(P＜0.05),对护理工作的满意度高于对照组(P＜0.05).结论:人性化综合护理能有效提高普外科重症监护患者的抢救成功率,促进患者恢复,缩短患者住院时间,降低患者焦虑情绪,最终提高其对护理工作的满意率,值得临床推广应用.