基于老年重症关怀病房构建老年危重症友善管理模式的可行性和安全性研究:一项前瞻性对照研究

Feasibility and safety study of building a friendly management model for elderly critically ill patients based on geriatric intensive care unit:a prospective controlled study

目的探讨将老年重症关怀病房(GICU)纳入老年危重症友善管理模式的可行性和安全性。方法采用前瞻性对照研究方法,选择2021年12月至2023年5月常州市金坛第一人民医院GICU和综合重症监护病房(ICU)收治的老年危重症患者作为研究对象。ICU组患者采用传统的重症诊疗及护理模式。GICU组患者除ICU组基础医护措施外,根据病情评估情况,加入弹性探视、诊疗环境优化、关怀式诊疗、家属参与式临终关怀等友善管理模式。记录并比较两组患者性别、年龄、主要诊断、入院时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ);治疗期间院内感染、非计划拔管、坠床/跌倒、非预期重返ICU/GICU等不良事件发生率和ICU/GICU病死率;以及患者ICU后综合征(PICS)发生率、患者/家属对医护满意率、患者/家属对诊疗环境满意率。结果按照ICU、GICU的收治标准以及患者和(或)家属的意愿,最终ICU组纳入59例患者,GICU组入组48例患者。两组患者性别、年龄、主要诊断、APACHEⅡ评分比较差异均无统计学意义,具有可比性。ICU组与GICU组患者治疗期间院内感染发生率〔13.6%(8/59)比12.5%(6/48)〕、非计划拔管发生率〔5.1%(3/59)比6.2%(3/48)〕、坠床/跌倒发生率〔3.4%(2/59)比0%(0/48)〕、非预期重返ICU/GICU率〔8.5%(5/59)比10.4%(5/48)〕、ICU/GICU病死率〔6.8%(4/59)比6.2%(3/48)〕等比较差异均无统计学意义(均P>0.05)。与ICU组相比,GICU组PICS发生率明显降低〔8.3%(4/48)比25.4%(15/59),P<0.05〕,患者/家属对医护满意率〔89.6%(43/48)比74.6%(44/59)〕、患者/家属对诊疗环境满意率〔87.5%(42/48)比67.8%(40/59)〕明显提高(均P<0.05)。结论将GICU作为老年危重症友善管理模式是可行且安全的,值得进一步探索和研究。

Objective To explore the feasibility and safety of integrating the geriatric intensive care unit(GICU)into the friendly management model of the elderly critically ill patients.Methods A prospective controlled study was conducted.Patients with elderly critically ill admitted to the GICU and the general intensive care unit(ICU)of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled.Patients in the ICU group received the traditional intensive care and nursing mode.In addition to the ICU group basic medical care measures,the patients in the GICU group were treated with friendly management models such as flexible visitation,diagnosis and treatment environment optimization,caring diagnosis and treatment,and family participation in hospice care according to their condition assessment.The gender,age,main diagnosis,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)at admission were recorded and compared between the two groups.During the treatment period,the incidence of nosocomial infection,unplanned extubation,falling out of bed/fall,unexpected readmission to ICU/GICU,and ICU/GICU mortality,the incidence of post-intensive care syndrome(PICS),the satisfaction rate of patients/families with medical care,and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.Results According to the admission criteria for ICU and GICU,as well as the willingness of the patients and/or their families,a total of 59 patients were finally included in the ICU group,and 48 patients were enrolled in the GICU group.There were no significantly differences in gender,age,main diagnosis and APACHEⅡscore between the two groups,and there were comparability.There were no significantly differences in the incidence of adverse events such as nosocomial infection[13.6%(8/59)vs.12.5%(6/48)],unplanned extubation[5.1%(3/59)vs.6.2%(3/48)],falling out of bed/fall[3.4%(2/59)vs.0%(0/48)],unexpected readmission to ICU/GICU[8.5%(5/59)vs.10.4%(5/48)],and ICU/GICU mortality[6.8%(4/59)vs.6.2(3/48)]between the ICU group and GICU group(all P>0.05).Compared with the ICU group,the incidence of PICS in GICU group was significantly lower[8.3%(4/48)vs.25.4%(15/59),P<0.05],the satisfaction rate of patients/families with medical care[89.6%(43/48)vs.74.6%(44/59)]and satisfaction rate of patients/families with diagnosis and treatment environment[87.5%(42/48)vs.67.8%(40/59)]were significantly increased(both P<0.05).Conclusion The use GICU as a friendly management model for elderly critically ill patients is feasible and safe,and it is worthy of further exploration and research.