重症监护病房患者自理能力纵向调查研究

Longitudinal Study on Self-care Ability of Surviving Patients in the Intensive Care Unit

背景大量学者研究发现重症监护病房(ICU)内各种先进的诊疗设备,为患者提供了良好救治条件,延长患者生命的同时,对患者的生理、认知及心理产生严重不良影响,使患者的自理能力很难或延迟恢复到治疗前水平,严重影响患者生存质量。目的明确ICU患者转出前24 h及转出后1周、3个月、6个月的自理能力及其自理能力的影响因素。方法2017年10月—2018年10月选择在大连市第二人民医院综合ICU接受治疗、符合入选标准的患者作为研究对象。收集其一般资料,采用Barthel指数(BI)评定量表评价ICU患者转出前24 h及转出后1周、3个月、6个月的自理能力,并比较不同时间、特征的ICU患者的自理能力。ICU患者自理能力的影响因素分析采用多重线性回归分析,相关性分析采用Pearson相关分析。结果共发放问卷196份,回收有效问卷134份,问卷有效回收率为68.4%。ICU患者自理能力随转出ICU时间的增加而增加(χ^2趋势=244.00,P<0.001)。不同年龄、入住ICU时间、机械通气方式、机械通气时间、急性生理与慢性健康评分(APACHEⅡ评分)情况的ICU患者转出前24 h、转出后1周BI评定量表总分比较,差异均有统计学意义(P<0.05)。不同年龄、婚姻状况、入住ICU时间、机械通气方式、机械通气时间、APACHEⅡ评分情况的ICU患者转后3个月、6个月BI评定量表总分比较,差异均有统计学意义(P<0.05)。多重线性回归分析结果显示,年龄、APACHEⅡ评分是ICU患者转出前24 h、转出后1周、3个月、6个月BI评定量表总分的影响因素(P<0.05)。ICU患者转出前24 h(r=-0.44、-0.35)、转出后1周(r=-0.36、-0.31)、3个月(r=-0.51、-0.26)、6个月(r=-0.49、-0.16)的BI评定量表总分与其年龄、APACHEⅡ评分均呈负相关(P<0.05)。结论ICU患者自理能力较差,转出后6个月,134例患者中仅有34例患者自理能力为无需依赖,并且年龄越大、APACHEⅡ评分越高的患者自理能力越低。

Background Researchers have found that good treatment conditions supported by advanced medical equipments in the intensive care unit(ICU) have increased the likelihood of patients’ survival.Despite reaching this milestone,many survivors face physical,cognitive,and psychological sequelae,which results in delay or inability to return to premorbid self-care ability,seriously affecting the quality of life of survivors and their families.Objective To evaluate the self-care ability levels and influencing factors in patients within 24 hours before ICU discharge,and at 1 week,3 months and 6 months after ICU discharge.Met hods Participants meeting the inclusion and exclusion criteria were selected from General ICU,the Second People’s Hospital of Dalian City during October 2017 to October 2018.Basic information and Barthel Index(BI)-rated selfcare levels within 24 hours before ICU discharge,and at 1 week,3 months and 6 months after ICU discharge were collected.And self-care levels were compared by measurement time and personal factors.Multiple linear regression analysis was used to analyze influencing factors of self-care level.Pearson correlation analysis was performed to investigate the correlation between self-care level and clinical factors.Results A total of 196 patients were investigated.134 effective questionnaires were collected,with an effective recovery rate of 68.4%.With the growth of time after ICU discharge,self-care ability gradually recovered(χ2trend=244.00,P<0.001).The total BI score within 24 hours before ICU discharge differed significantly by age,length of ICU stay,mode and duration of mechanical ventilation,as well as APACHE Ⅱ score(P<0.05).The total BI score at 1 week after ICU discharge differed obviously by age,length of ICU stay,mode and duration of mechanical ventilation,as well as APACHE Ⅱ score( P<0.05).The total BI score at 3,and 6 months after ICU discharge changed obviously according to age,marital status,length of ICU stay,mode and duration of mechanical ventilation,and APACHE II score( P<0.05).The result of multiple linear regression analysis showed that age and APACHE Ⅱ score were associated with the total BI score within 24 hours before ICU discharge,at1 week,3 months and 6 months after ICU discharge.Age was negatively correlated with the total BI score within 24 hours before ICU discharge,at 1 week,3 months and 6 months after ICU discharge(r=-0.44,-0.36,-0.51,-0.49),and so did the APACHE Ⅱ score(r=-0.35,-0.31,-0.26,-0.16)(P<0.05).Conclusion In general,the survivors have poor selfcare ability,only 34 of the 134 participants are independent,and with the growth of age and APACHE II,the self-care ability gradually declines.