ICU后综合征的病理生理学和中西医结合防治进展

Progress in pathophysiology and integrated traditional Chinese and Western medicine of post-intensive care syndrome

随着重症监护病房(ICU)救治能力的不断提高,许多病情危重、复杂的患者得益于技术的发展而存活下来,但大部分患者因ICU后综合征(PICS)合并的心理、生理问题导致生活质量下降。因此PICS的早期识别与防治尤其关键,认识PICS的病理生理机制,在ICU住院期间严格执行ABCDEFG集束化管理措施〔包括气道管理(A),呼吸(B),合理镇痛镇静治疗(C),谵妄的防治(D),重症患者的早期活动和功能锻炼(E),家人的激励(F),良好的沟通(G)〕,关注合理的营养支持,优化血糖管理,通过家属的鼓励陪伴以及ICU日记等形式对患者进行积极的心理干预支持,对ICU转出/出院患者的健康状况进行随访,提供多学科联合专业的延续性医疗服务,找到中医干预的切入点和时机,发挥中西医结合治疗的优势,可改善患者的生活质量。本文从PICS发生的病理生理机制、危险因素、防治管理措施、中医辨证论治等方面进行综述,以期提高临床医师对重症患者PICS的早期识别和诊治水平,改善患者预后。

With the continuous improvement of treatment ability in intensive care unit(ICU),many critically ill and complex patients have survived due to the development of technology.However,most of them suffer from the psychological and physiological problems of post-intensive care syndrome(PICS).Therefore,the early identification and prevention of PICS is particularly critical.We should understand the pathophysiological mechanism of PICS,strictly implement ABCDEFG bundle management measures[including airway management(A),breath(B),reasonable analgesia and sedation treatment(C),prevention of delirium(D),early rehabilitation(E),family engagement(F),good communication(G)]during ICU hospitalization,and pay attention to reasonable nutritional support,optimizing blood glucose management,providing positive psychological intervention and support to patients through family members'encouragement and accompanying,ICU diary and other forms,following up the health status of patients transferred out/discharged from ICU,providing multi-disciplinary and professional continuing medical services,finding the entry point and timing of traditional Chinese medicine intervention,and giving full play to the advantages of integrated traditional Chinese and Western medicine treatment,which can improve the quality of life of patients.This article reviews the pathophysiological mechanism,risk factors,prevention and management measures,traditional Chinese medicine syndrome differentiation and treatment of PICS,in order to improve the early identification,diagnosis and treatment of critical patients with PICS,and improve the prognosis of patients.