医院-社区一体化管理模式在ICU出院患者中的效果评价

Evaluation of the effect of integrated hospital-community management model in ICU discharged rehabilitation patients

目的探讨医院-社区一体化管理模式在重症监护室(ICU)出院患者中的应用效果,旨在改善患者生理功能、心理状态和认知功能,预防ICU后综合征(PICS)的发生,为提高ICU出院患者生存质量奠定基础。方法选择2020年1月—2022年10月福建省立医院(金山院区)ICU收治且已康复出院的160例患者为研究对象,按照组间基线资料具有可比性原则将其分为对照组和观察组,每组80例,对照组出院后采用电话随访干预,观察组则采用医院-社区一体化管理模式,对两组患者干预前、干预12个月后的生理功能、心理状态、认知功能进行评估,并统计其在出院后第1、6、12个月的PICS发生率。结果干预12个月后,观察组患者Barthel指数(BI)、肌力评分表(MRC)评分均高于对照组,观察组患者6 min步行距离长于对照组,差异均有统计学意义(P<0.05)。干预12个月后,观察组患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑自评量表(GAD-7)评分均低于对照组,差异有统计学意义(P<0.05)。干预12个月后,观察组患者简易精神状态量表(MMSE)中各维度评分均高于对照组,差异有统计学意义(P<0.05)。观察组在随访第6、12个月的PICS发生率均低于对照组,差异有统计学意义(P<0.05)。结论医院-社区一体化管理模式能有效改善ICU出院患者的生理功能、心理状态和认知功能,从而预防PICS的发生。

Objective To investigate the effect of hospital-community integrated management model in patients discharged from intensive care unit(ICU)for rehabilitation,aiming to improve patients'physiological function,psychological state and cognitive function,prevent the occurrence of post-ICU syndrome(PICS),and lay the foundation for improving the quality of survival of patients discharged from ICU for rehabilitation.Methods A total of 160 patients admitted to the ICU of Fujian Provincial Hospital(Jinshan Hospital District)and discharged from the ICU from January 2020 to October 2022 were selected as the study subjects,they were divided into a control group and an observation group of 80 patients each according to the principle of comparability of baseline data between the groups,and the control group was followed up by telephone after discharge,while the observation group adopted the hospital-community integrated management model.In the control group,telephone follow-up intervention was used after discharge,while in the observation group,hospital-community integration was used.Physical function,psychological state,and cognitive function of the patients in the two groups were evaluated before intervention and 12 months after intervention,and the incidence of PICS in the first,sixth,and twelfth months after discharge was also counted.Results After 12 months of intervention,patients in the observation group had higher Barthel Index(BI)and Muscle Strength Rating Scale(MRC)scores than those in the control group,and patients in the observation group had a longer 6 min walking distance than those in the control group,with statistically significant differences(P<0.05).After 12 months of intervention,patients in the observation group had lower scores on the Depression Scale of the Health Questionnaire(PHQ-9)and the Generalised Anxiety Disorder-7(GAD-7)Scale than those in the control group,the differences were statistically significant(P<0.05).After 12 months of intervention,the scores of all dimensions in the Brief Mental State Scale(MMSE)of patients in the observation group were higher than those of the control group,the difference was statistically significant(P<0.05).The incidence of PICS in the observation group was lower than that in the control group at the 6th and 12th months of follow-up,and the difference was statistically significant(P<0.05).Conclusion The integrated hospital-community management model can effectively improve the physiological function,psychological state and cognitive function of ICU discharged rehabilitation patients,thus preventing the occurrence of PICS.