Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with postintensive care unit syndrome

BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharge from the intensive care unit(ICU).These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family.Connect,Introduce,Communicate,Ask,Respond,Exit(CICARE)communication advocates that patients should be respected and accepted when receiving medical services.Clinicians should attach importance to the communication mode of feelings,including connection,introduction,communication,ask,response,and exit 6 steps.AIM To assess the impact of CICARE communication on the reduction of anxiety,depression,and post-traumatic stress disorder(PTSD)symptoms in patients transitioning from the ICU to other care settings.METHODS This prospective,randomized,controlled study was performed between October 2021 and March 2023.Intensive Care Unit Memory Tool was used to evaluate patients’ICU memory.The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms.Impact of Event Scale-Revised was utilized to assess the presence of PTSD.All data were processed and analyzed using R language software version 4.1.0.The measurement data were expressed as mean±SD,and the t test was used.The count data were analyzed by theχ2 test and expressed as[n(%)].RESULTS In total,248 subjects were included in this study.Among them,206 were successfully followed up for three months after transfer from the ICU,and 42 cases were lost to follow-up.There was no significant difference in the composition of ICU memory between the two groups.The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model,as well as the adoption of only the motivational psychological intervention nursing model,demonstrated favorable effects on PICS.Both groups of patients showed a reduction in anxiety scores,depression scores,and PTSD scores following the implementation of these two nursing models.However,it is noteworthy that the experimental group exhibited greater improvements compared to the control group.CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants;however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Effects of the prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome patients:An observational retrospective study

Objective:To investigate the effect of the first prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome(ARDS)patients with and without COVID.Methods:This study was conducted retrospectively with 22 COVID-ARDS and 22 non-COVID ARDS patients,who were placed in a prone position for at least 16 hours on the first day at the intensive care unit admission,and arterial blood gas analysis was taken in the pre-prone,prone and post-prone periods.Results:PaO2 were significantly increased in the pre-prone vs.prone comparison in both groups,but the increase in the PaO2/FiO2 ratio was not significant.In comparing the pre-prone vs.post-prone PaO2/FiO2 ratios,there was a significant difference only in the non-COVID ARDS group.Conclusions:The improved oxygenation provided by prone positioning is more permanent with the“post-prone effect”in non-COVID ARDS patients.This can be attributed to the differences in the pathogenesis of the two ARDS types.

Correlation between circulating endothelial cell level and acute respiratory distress syndrome in postoperative patients

BACKGROUND Acute respiratory distress syndrome(ARDS)is injury of alveolar epithelial cells and capillary endothelial cells caused by various factors,including endogenous and exogenous lung factors,leading to diffuse pulmonary interstitial and alveolar edema,and acute respiratory failure.ARDS involves alveolar epithelial cells and pulmonary interstitial capillary endothelial cells.Circulating endothelial cells(CECs)are the only marker that directly reflects vascular endothelial injury in vivo.There have been few studies on the correlation between peripheral blood CECs and ARDS at home and abroad.The lungs are the organs with the highest capillary density and the most endothelial cells,thus,it is speculated that when ARDS occurs,CECs are stimulated and damaged,and released into the circulatory system.AIM To explore the correlation between CEC level and severity of ARDS in patients postoperatively.METHODS Blood samples were collected from all patients on day 2(d2)and day 5(d5)after surgery.The control group comprised 32 healthy volunteers.Number of CECs was measured by flow cytometry,and operation time was recorded.Changes in various indexes of patients were monitored,and diagnosis of ARDS was determined based on ARDS Berlin definition.We comprised d2 CECs in different groups,correlation between operation time and d2 CECs,ARDS of different severity by d2 CECs,and predictive value of d2 CECs for ARDS in postoperative patients.RESULTS The number of d2 CECs in the ARDS group was significantly higher than that in the healthy control group(P<0.001).The number of d2 CECs in the ARDS group was significantly higher than that in the non-ARDS group(P<0.001).The number of d2 CECs in the non-ARDS group was significantly higher than that in the healthy control group(P<0.001).Operation time was positively correlated with number of CECs on d2(rs=0.302,P=0.001).The number of d2 CECs in the deceased group was significantly higher than that in the improved group(P<0.001).There was no significant difference in number of d2 CECs between patients with mild and moderate ARDS.The number of d2 CECs in patients with severe ARDS was significantly higher than that in patients with mild and moderate ARDS(P=0.041,P=0.037).There was no significant difference in number of d5 and d2 CECs in the non-ARDS group after admission to intensive care.The number of d5 CECs was higher than the number of d2 CECs in the ARDS improved group(P<0.001).The number of d5 CECs was higher than the number of d2 CECs in the ARDS deceased group(P=0.002).If the number of CECs was>1351/mL,sensitivity and specificity of predicting ARDS were 80.8%and 78.1%,respectively.CONCLUSION Changes in number of CECs might predict occurrence and adverse outcome of ARDS after surgery,and higher numbers of CECs indicate worse prognosis of ARDS.

Alveolar Hemorrhage and Acute Respiratory Distress Syndrome Associated with Pulmonary Cement Following Percutaneous Vertebroplasty with Polymethylmethacrylate

We report a rare complication of diffuse alveolar hemorrhage and respiratory failure following percutaneous vertebroplasty in a patient who has evidence of cement leakage. Cement injection was done two days prior to presentation and covered 2 vertebral levels for osteoporosis induced fractures.

黄芪桂枝五物汤加减联合针刺治疗重症骨创伤患者ICU获得性衰弱的疗效

目的观察黄芪桂枝五物汤加减联合针刺治疗重症骨创伤患者重症监护病房(intensive care unit,ICU)获得性衰弱的效果。方法将66例重症骨创伤ICU获得性衰弱患者,按照随机数字表法分为对照组33例和观察组33例。对照组给予功能锻炼,观察组在此基础上联合黄芪桂枝五物汤加减联合针刺,连续治疗2周。比较两组的临床疗效、机械通气时间、ICU住院天数、日常生活活动能力Barthel指数(BI)评分、APACHEⅡ评分、肌力状态(MRC)评分。结果观察组的有效率90.91%(30/33),高于对照组的有效率69.70%(23/33)(P<0.05);观察组机械通气天数、住ICU时间明显短于对照组(P<0.05);治疗14d,观察组患者的BI等级优于对照组(P<0.05);治疗3d、治疗5d、治疗7d的观察组的APACHEⅡ评分明显低于对照组,肌力状态MRC评分明显高于对照组(P<0.05)。结论黄芪桂枝五物汤加减联合针刺治疗能明显缩短重症骨创伤ICU获得性衰弱患者的机械通气时间、ICU住院天数,提高日常活动能力,改善肢体肌力,更利于促进疾病康复。

ICU患者中心静脉导管拔除意外综合征风险的列线图预测模型构建与验证

目的探讨重症监护室(ICU)患者中心静脉导管(CVC)拔除意外综合征的影响因素,构建风险预测模型,并进行验证。方法回顾性收集2018年1月-2022年12月在我院ICU接受CVC置管3016例患者,根据是否发生CVC拔除意外综合征,分为发生组28例和未发生组2988例。比较2组一般资料,采用logistic回归分析其危险因素,探讨护理预防措施。结果ICU患者CVC拔除意外综合征发生率为0.93%,年龄≥65岁、置管时间≥7d、冠心病史、导管相关血流感染、空气栓塞是ICU患者发生CVC拔除意外综合征的危险因素。利用上述5个因素构建列线图模型,并对列线图模型进行内部验证,绘制校准曲线图显示校正曲线与理想曲线拟合良好,HosmerLemeshow拟合优度检验结果显示,χ^(2)=7.240,P=0.412,模型拟合优度良好。AUC=0.742,灵敏度为69.08%,特异度为79.32%,预测结果较好,DCA曲线和临床决策曲线均表明具有较好的临床实用性。结论年龄≥65岁、置管时间≥7d、冠心病史、导管相关血流感染和空气栓塞是ICU患者发生CVC拔除意外综合征的独立危险因素,基于此建立的列线图模型对于护理工作者早期干预,降低CVC拔除意外综合征的风险具有重要意义。

ICU护士预防再喂养综合征知识、态度和行为的现况及其影响因素

目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeeding syndrome,RFS)知识、态度和行为问卷以及护理阻碍因素及知识需求问卷,对上海市5所三级甲等综合医院和2所二级甲等综合医院的366名ICU护士进行调查,并采用多重线性回归分析RFS的知识、态度和行为的影响因素。结果366名ICU护士预防RFS知识、态度和行为问卷总分、知识维度、态度维度、主观规范、感知行为控制及行为意向维度得分分别为(133.73±20.55)分、(35.79±9.04)分、(37.44±6.20)分、(12.07±2.27)分、(17.82±4.00)分、(30.61±6.09)分,总分处于中等水平。多重线性回归分析显示,医院级别、ICU类型以及是否为营养学组成员、接受过相关培训、从学术期刊获取知识的频率是ICU护士对预防RFS知识、态度和行为的影响因素(均P<0.05),共同解释其20.90%的变异。结论从学术期刊获取知识、三级医院、综合ICU及接受过RFS相关知识培训、营养学组成员的护士有较高的预防RFS知识、态度和行为水平。护理管理者应重视ICU护士的培训,加强其对预防RFS护理的知识和行为,从而提高ICU护理管理质量。

ICU患者再喂养综合征管理及预后的研究进展

再喂养综合征(RFS)是长期营养不良患者重新摄入营养初期机体代谢异常所导致的一系列危及生命的临床症状,由于缺乏特异性,不易辨别,其在ICU患者中死亡率较高。目前,国内学者对RFS的治疗管理和预后影响的研究报道较少,且具体管理措施仍然存在争议。此外,对于RFS预后研究的方法和结论同样存在差异。故该文拟从ICU患者RFS的诊断标准及发生现状、管理现况、疾病预后方面进行系统综述,旨在为医护人员就RFS的管理提供经验借鉴,为后续相关研究提供参考。

重症监护患者再喂养综合征发生率及危险因素的Meta分析

目的 明确重症监护(intensive care unit, ICU)患者再喂养综合征(refeeding syndrome, RFS)发生率及危险因素,为早期识别和预防再喂养综合征提供依据。方法 计算机检索国内外数据库中与ICU患者RFS发生率及危险因素相关的文献,检索时限为建库至2023年5月31日,利用Stata 17软件进行Meta分析。结果 共纳入21篇文献,总样本量5056例,阳性病例1935例,RFS发生率37.88%[95%CI(30.33%~45.43%)]。其中,年龄(MD=3.40)、合并糖尿病(OR=2.49)、体质量指数(MD=-1.21)、急性生理与慢性健康评分(MD=2.63)、序贯器官功能衰竭评分(MD=1.87)、格拉斯哥昏迷评分(MD=-2.53)、重症营养风险评分(MD=1.00)、血清磷水平(MD=-0.45)、血清钾水平(MD=-0.38)、血清钙水平(MD=-0.19)、血清钠水平(MD=-2.96)、白蛋白水平(MD=-1.64)、前白蛋白水平(MD=-67.83)等13项为ICU患者发生RFS的危险因素(均P<0.01)。结论 护理人员可依据上述危险因素早期识别ICU患者RFS高发人群,及时采取针对性措施,从而改善患者的预后。

Determination of functional prognosis in hospitalized patients following an intensive care admission

AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).RESULTS Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P < 0.05) were the KATZ and MRC on admission, age, sepsis(no), and total length of stay(TLS). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLS(AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLS(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the ΔMRCTOT.CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

重症烧伤并发肠系膜上动脉综合征的营养治疗策略分析

回顾性分析烧伤重症监护病房(BICU)收治的4例重症烧伤并发肠系膜上动脉综合征(SMAS)患者的临床资料。患者为3女1男,其中1例为女性儿童。烧伤原因均为火焰烧伤,深度以Ⅱ~Ⅲ°为主,入院时均合并有不同严重程度吸入性损伤。将患者按年龄从小到大编号, 1、2、3、4号患者年龄分别为10、30、40、62岁,烧伤总面积为70%~92%、平均烧伤总面积(80.5±12.2)%,Ⅲ°烧伤面积为55%~80%、平均Ⅲ°烧伤面积(68.8±13.1)%。2号患者于伤后3 h直接收治入本院, 1、3、4号患者分别于伤后456、192及16 h由外院转入本院。并发SMAS的时间分别为伤后20、35、10、50 d。4例患者SMAS诊断均通过临床症状、腹部X线平片和腹部CT结果综合判定。SMAS确诊后治疗上予禁食,留置鼻胃管和鼻空肠管,胃肠减压,翻身床俯卧位治疗,肠内、肠外营养支持。深度烧伤创面早期采用切削痂后异体皮临时覆盖,后期分别用自体MEEK皮、网状皮或邮票皮移植修复创面。4例患者分别行5、8、6、7次手术,分别禁食和胃肠减压3、4、7、5 d,鼻空肠管肠内营养支持治疗13、29、60、17 d,鼻胃管肠内营养支持治疗42、70、97、45 d,肠外营养支持治疗17、53、81、25 d后,患者体重增加,营养指标显著改善,创面均完全愈合后出院,随访6~36个月后SMAS无复发。

基于风险预测的干预模式在重症监护室肝癌合并再喂养综合征患者中的应用效果

目的探讨基于风险预测的干预模式在重症监护室(ICU)肝癌合并再喂养综合征(RFS)患者中的应用效果。方法根据干预方式的不同将96例ICU肝癌合并RFS患者分为常规组(n=47,常规营养支持干预)和风险预测组(n=49,基于风险预测的干预模式)。比较两组患者的电解质指标(磷离子、钾离子、镁离子)、营养指标[血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]及并发症发生情况。结果干预后第5天,两组患者磷离子、钾离子、镁离子、Hb、ALB、PAB水平均高于本组干预前,风险预测组患者磷离子、钾离子、镁离子、Hb、ALB、PAB水平均高于常规组,差异均有统计学意义(P﹤0.05)。干预后1个月,两组患者EORTC QLQ-C30各维度评分均高于本组干预前,风险预测组患者EORTC QLQ-C30各维度评分均高于常规组,差异均有统计学意义(P﹤0.05)。风险预测组患者并发症总发生率明显低于常规组(P﹤0.01)。结论基于风险预测的干预模式在ICU肝癌合并RFS患者中的应用效果显著,可改善电解质水平及营养状态,提高生活质量,降低并发症发生率。

儿童急性呼吸窘迫综合征机械通气策略研究现状

儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,PARDS)是儿童重症监护病房(PICU)内相对常见的危重症,PICU内发病率约占3%。ARDS患儿病死率较高,虽然近十几年来较前有所下降,仍高达约18%,部分发展中国家近2~3年甚至可高达40%~50%。合理的机械通气策略有助于改善患儿预后。本文就PARDS的机械通气策略研究现状进行综述。

ICU医护人员急性呼吸窘迫综合征俯卧位通气知信行问卷的编制及信效度检验

目的 编制ICU医护人员急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)俯卧位通气的知信行问卷并进行信效度检验。方法 依据知信行理论模型,通过文献学习、理论分析、专家访谈、德尔菲专家函询、预调查形成初始问卷,于2022年10月-11月选取安徽省7所三级综合性医院的426名ICU医护人员作为调查对象,进行信效度检验;于2023年1月-2月选取该7所三级综合性医院的另外455名ICU医护人员作为调查对象,用于验证性因子分析。结果 最终形成的问卷包含知识、信念、行为3个维度,共41个条目。探索性因子分析3个因子累计方差贡献率为65.319%,验证性因子分析各拟合指标均在可接受范围(χ^(2)/df=2.504,RMSEA=0.058,RMR=0.014,IFI=0.933,CFI=0.933,PGFI=0.740,PNFI=0.846,PCFI=0.883);问卷Cronbach’s α系数为0.982,重测信度为0.995,分半信度为0.950。结论 该问卷具有较好的信效度,适用于调查ICU医护人员对ARDS患者俯卧位通气知信行现况。

专科护士主导的肺复张模式在急性呼吸窘迫综合征患者康复中应用的有效性与可行性分析

目的探讨专科护士主导的肺复张(recruitment maneuver,RM)模式在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中应用的有效性与可行性,以便为临床提供一种新的管理模式。方法采用随机对照试验,选取2018年1月至2021年8月本院重症医学科(intensive care unit,ICU)ICU收治的40例ARDS患者为研究对象,采用随机数字表法将患者分为对照组和试验组各20例。对照组采用常规医生主导的RM模式,试验组采用ICU专科护士主导的RM模式。比较干预后(第二次RM后)两组患者动脉血气分析指标、机械通气时间、ICU入住时间、RM次数、RM方案调动次数和并发症发生情况。结果两组患者第二次RM后1h和24h的动脉血氧分压(partial pressure of arterial oxygen,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、氧合指数(oxygenation index,OI)、机械通气时间、ICU入住时间和RM次数比较,差异无统计学意义(均P>0.05);试验组RM方案调动次数多于对照组,差异有统计学意义(P<0.05);两组均无并发症发生。结论ICU专科护士主导的RM模式在ARDS患者的应用可取得较好临床疗效,具有安全性和可行性。

神经内科重症监护病房病人再喂养综合征现状及影响因素研究

目的:调查神经内科重症监护病房(NICU)病人再喂养综合征(RFS)现状,并分析其影响因素。方法:采用便利抽样法,选取2021年1月—2021年10月上海市某三级甲等医院NICU病人作为研究对象,根据病人是否发生RFS分为RFS组(47例)和非RFS组(103例)。采用自制的RFS危险因素筛查表、营养风险筛查量表(NRS-2002)、格拉斯哥昏迷评分(GCS)、序贯器官衰竭评分(SOFA)对病人进行调查。结果:150例病人中47例发生RFS,RFS发生率为31.3%。Logistic回归分析显示,年龄、SOFA评分、颅脑手术、入NICU的48 h内开始喂养、每日蛋白质摄入情况是NICU病人发生RFS的独立影响因素。结论:应从年龄、SOFA评分、颅脑手术等方面对NICU病人进行综合评估,筛选出RFS高危人群,制定个体化的营养治疗方案,预防RFS发生。