重症加强治疗病房清醒患者不良住院经历调查分析

目的 调查重症加强治疗病房(ICU)清醒危重患者住院期间心理及生理不良经历的发生情况,并分析相关诱发因素.方法 选择全国31家三级甲等医院ICU进行为期2个月的连续性调查,所有转出ICU的清醒患者均入选本次调查,于转出后2 d内由上海诺德健康咨询有限公司委派、经课题组系统培训合格的访问员按问卷要求独立对患者进行访问.结果 共计234例患者接受调查,其中163例(69.6%)发生了心理不良经历;有生理不良经历患者的比例高达97.0%,其中74.8%的患者发生了严重生理不良经历.有86.5%存在心理不良经历的患者发生了严重生理不良经历,显著高于无心理不良经历的患者(46.5%),差异有统计学意义(P<0.01).分别有65.8%和74.8%的患者抱怨对噪音及医护操作难以忍受,且此类患者心理及生理不良经历的比例均较能耐受者显著增高(P<0.05或P<0.01).多因素分析发现,急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分为诱发心理不良经历的独立高危因素[优势比(OR)=1.070,95%可信区间(CI)为1.020～1.130,P<0.05];年龄因素为发生生理不良经历的高危因素(OR=0.936,95%CI为0.879～0.998,P<0.05).此外,恰当的镇静能有效降低ICU清醒危重患者心理及生理不良经历的发生率.结论 ICU清醒危重患者不良住院经历发生率高,存在心理不良经历的患者更容易出现生理不良经历.疾病严重程度是诱发不良心理经历的独立危险因素,ICU环境因素(如噪音)以及医护操作与心理及生理不良经历关系密切,而恰当的ICU镇静策略是减少心理及生理不良经历的有效措施之一.

Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay

OBJECTIVE: To survey the incidences of psychological and physiological unpleasant experiences in conscious critically ill patients during their intensive care unit (ICU) stay, and investigate the inducing factors. METHODS: A two-month consecutive nationwide investigation was prospectively performed in 31 academic hospital ICUs. An in-person questionnaire interview to each conscious patient was performed by specific trained staff from RMC-ROMIT Healthcare Consulting Company within 2 days after the patient was transferred from ICU. RESULTS: Two hundred and thirty-four cases were interviewed in this survey. One hundred and sixty-three of the 234 patients (69.6%) appeared psychological unpleasant experience. The ratio of patients with physiological unpleasant experience was as high as 97.0%, and 74.8% of whom were with serious physiological unpleasant experiences. The incidence of serious physiological unpleasant experiences was markedly higher in patients with than without psychological unpleasant experience (46.5% vs. 86.5%). The difference was shown to be statistical significant (P<0.01). The percentage of patients complained of ICU noise and medical or nursing manipulations not tolerable was 65.8% and 74.8%, respectively. Compared with the tolerable cases, the incidences of psychological and physiological unpleasant experiences were significantly increased in those patients (P<0.05 or P<0.01). Acute physiology and chronic health evaluationII (APACHEII) score was the independent high risk factor inducing psychological unpleasant experience through multiple factor analysis [odds ratio (OR)=1.070, 95% confidence interval (CI)=1.020-1.130,P<0.05]. Age was the high risk factor inducing physiological unpleasant experience (OR=0.936, 95% CI=0.879-0.998,P<0.05). In addition, adequate sedation significantly reduced the incidence of the psychological and physiological unpleasant experiences. CONCLUSION: A high incidence of unpleasant experience is found in conscious critically ill patients during their ICU stay. Patients with psychological unpleasant experiences are with higher possibility of occurring physiological unpleasant experiences. The data show that APACHEII score is the independent high risk factor inducing psychological unpleasant experiences. ICU environment, noise for instance, and medical or nursing manipulations are closely related with the incidence of psychological and physiological unpleasant experiences. Meanwhile, adequate sedation is one of the effective methods to reduce the incidences of them.