重症病人ICU后综合征的概念分析

Conceptual analysis of post-intensive care syndrome in critically ill patients

目的:分析并阐明重症病人重症监护室(ICU)后综合征概念的定义及其内涵。方法:系统检索中国知网、万方数据库、维普数据库、中国生物医学文献服务系统、PubMed、Web of Science、EMbase、CINAHL,根据纳入和排除标准选取63篇文献,应用Rodgers概念分析框架,从ICU后综合征概念的演化、概念属性、前因和后果、测量工具及相关概念等方面对ICU后综合征的相关内容进行分析、整合。结果:ICU后综合征包括新发或恶化的多维损伤、身体功能障碍、心理障碍、认知障碍、社会功能障碍、多维功能障碍在ICU转出后持续存在等6个概念属性;先决条件包括ICU相关因素、个人因素和疾病因素;结局包括对病人和家庭的影响。结论:通过概念分析明确了重症病人ICU后综合征的概念属性,未来还需结合我国国情对相关评估工具、影响因素和干预等进行深入研究,从而改善重症病人结局。

Objective:To analyze and clarify the definition and connotation of the concept of post-intensive care syndrome in critically ill patients.Methods:A systematic search was conducted in CNKI,WanFang Database,VIP,SinoMed,PubMed,Web of Science,EMbase,CINAHL.A total of 63 papers were selected according to the inclusion criteria,and the Rodgers concept analysis framework was applied to analyze the evolution,concept attributes,antecedents and consequences,measurement tools and related concepts of post-intensive care syndrome.Results:The post-intensive care syndrome included six conceptual attributes,new or worsening multidimensional impairment,physical dysfunction,psychological impairment,cognitive impairment,social dysfunction,and persistence of multidimensional dysfunction after ICU transfer;prerequisites included ICU-related factors,personal factors,and disease factors;and outcomes included the impact on patients and families.Conclusion:The conceptual attributes of post-intensive care syndrome in critically ill patients were clarified through conceptual analysis,and futher studies on relevant assessment tools,influencing factors and interventions are needed in the future to improve the outcomes of critically ill patients in Chinese context.