慢性危重症的特点及预测因素研究进展

Characteristics and predictive factors of chronic critical illness

随着现代循证医学的开展及医疗水平的提高,部分重症患者经治疗渡过了最初的急性疾病期存活下来,但仍存在持续的器官衰竭,需要长期依赖重症监护和脏器支持。这些患者经历持续的器官功能损害,甚至长期处于持续炎症、免疫抑制和分解代谢综合征状态,即进展到慢性危重症。慢性危重症容易出现身体、心理和认知相关的功能障碍,具有高死亡率和高致残率,这些患者的健康并没有得到保护,而是通过技术延长生存时间。往往存在住院时间较长、承受永久性残疾和严重的痛苦、生活质量降低,影响到患者整个家庭。目前慢性危重症的定义尚未统一,但标准都是以一定时间的住院时长加上严重的器官功能损害为基础。多国的流行病学调查均显示慢性危重症发病率逐年增加,且随着人口老龄化,已成为一个日益严重的全球性问题。目前开展了许多研究,在持续炎症、免疫抑制和分解代谢基础上探讨慢性危重症的发病机制及危险因素,预测慢性危重症的发展,以减轻慢性危重症对患者及家庭的影响。现将慢性危重症定义、流行病学、发病机制及预测因素的研究进展进行综述,以便临床医师更好地认识及预防慢性危重症,为慢性危重症的诊治提供参考,丰富慢性危重症患者的诊疗策略以进一步提高慢性危重症患者的生存质量。

With the development of modern evidence-based medicine and the improvement in intensive-care technology,some critically ill patients who survive from the initial acute critical state after treatment are bound to have persistent organ dysfunctions.Accordingly,they need to rely on intensive care and organ support for a long time.These patients experience persistent organ damage and even chronically persistent inflammation,immunosuppression,and catabolic syndrome that progress to chronic critical illness.Chronic critical illness is prone to physical,psychological,and cognitive-related dysfunction,with high mortality and morbidity.The health of these patients is not protected,but the time to death is prolonged by technology.They are often hospitalised for longer periods of time,suffer permanent disability and severe distress,reduce their quality of life,and affect their entire family.At present,the definition of chronic critical illness has not been unified,but the standard is based on a certain length of hospitalisation plus severe organ damage.Epidemiological surveys in many countries have shown that the incidence of chronic critical illness increases yearly.With the aging of the population,it has become an increasingly serious global problem.Many studies have been performed to explore the pathogenesis and risk factors of chronic critical illness,predict the development of chronic critical illness,and reduce the impact of chronic critical illness on patients and their families.This review aims to summarise the progress of research on the definition,epidemiology,pathogenesis,and predictive factors of chronic critical illness to improve clinicians'understanding and ability to prevent chronic critical illness.We provide a reference for the diagnosis and treatment of chronic critical illness,as well as enrich the knowledge of diagnosis and treatment strategies to further improve the quality of life of chronic critical-illness patients.