机械通气患者重症监护获得性衰弱现状及危险因素的分析

Risk Factors of Intensive Care Unit Acquired Weakness among Patients with Mechanical Ventilation

目的 探讨机械通气患者重症监护获得性衰弱(intensive care unit acquired weakness,ICU-AW)的发生现状及其危险因素.方法 便利抽样法选取2017年11月至2018年6月在湖州市某三级甲等医院重症医学科接受机械通气治疗的患者165例为研究对象,采用自制的机械通气患者ICU-AW危险因素调查表、医学研究委员会评分,收集患者的基本资料及治疗情况,使用Logistic回归分析筛选出ICU-AW的危险因素.结果 机械通气患者并发ICU-AW69例,发生率为41.82%.不同ICU入住时间、入院时APACHEⅡ评分、机械通气方式、机械通气时间、血糖水平、乳酸水平以及是否采用连续性肾脏替代治疗、胃肠外营养和是否发生低蛋白血症、多器官功能衰竭、脓毒症以及是否应用镇静镇痛药、糖皮质激素的患者,其在是否发生ICU-AW上的差异均有统计学意义(均P<0.05).Logistic回归分析显示,并发多器官功能衰竭、使用糖皮质激素治疗、接受连续性肾脏替代治疗、血乳酸水平升高是机械通气患者ICU-AW的危险因素.结论 机械通气患者ICU-AW发生率较高,护理工作中应采取预见性的护理措施,有针对性地消除或减轻危险因素,做好机械通气患者的护理.

Objective To explore the occurrence of intensive care unit acquired weakness(ICU-AW) and its risk factors among ICU patients with mechanical ventilation.Methods By the convenience sampling method,a total of 165 patients treated with mechanical ventilation in the department of critical care medicine in a tertiary hospital from November 2017 to June 2018 were selected.The basic data and treatment of the patients were collected by using the self-made questionnaire on the risk factors of ICU-AW and the Medical Research Committee scale.Logistic regression analysis was used to screen out the risk factors of ICU-AW. Results There were 69 patients complicated with ICU-AW,with an incidence rate of 41.82%.There were significant differences in ICU-AW occurrence among patients with different ICU stay time,Apache Ⅱ score,mechanical ventilation mode,mechanical ventilation time,blood glucose level,lactate level,continuous renal replacement therapy,parenteral nutrition,hypoproteinemia,multiple organ failure,sepsis,the usage of sedative and analgesic drugs and glucocorticoids(all P<0.05).Logistic regression analysis showed that multiple organ failure,glucocorticoid therapy,continuous renal replacement therapy and increased blood lactate level were the risk factors of ICU-AW.Conclusions The incidence of mechanical ventilation patients complicated with ICU-AW is relatively high.In the nursing work,it is necessary to take predictive nursing measures to eliminate or reduce the risk factors,and take good care of patients with mechanical ventilation.