老年患者ICU后综合征早期变化的纵向研究及影响因素分析

Longitudinal study on early changes of post-ICU syndrome in elderly patients and analysis of their influencing factors

中文关键词: 老年  ICU后综合征  纵向研究  影响因素

英文关键词: elderly  post-intensive care syndrome  longitudinal study  influencing factor

中文摘要:

      目的 探究老年患者ICU后综合征相关症状的纵向变化,并分析其相关影响因素.方法 采用时间连续性抽样法选取2022年1月1日—12月31日入住并转出上海市某三甲医院3个ICU的老年患者为研究对象.ICU住院期间收集其社会人口学资料和疾病资料.采用Barthel指数评定量表、体质量指数、握力、疼痛评分、疲劳评定量表、医院焦虑抑郁量表、事件影响量表-修订版、简易精神状态量表共9个量表或指标调查患者在转出ICU1周(T0)、1个月(T1)、3个月(T2)时的症状.结果 共纳入207例患者.9个指标中,Barthel指数、握力数值和MMSE评分随时间变化逐渐升高;体质量指数的数值在T0到T2无显著变化;疼痛评分、抑郁和焦虑评分随时间变化逐渐下降;疲劳评分在T0到T1阶段缓慢下降,而在T1到T2阶段回升;PTSD评分在T0到T1阶段增加,在T1到T2阶段下降.影响因素分析发现有运动习惯、未进行手术为疲劳状况在T1到T2的保护因素,而ICU停留时间的增加、更高的APACHE Ⅱ评分、接受机械通气和合并症为危险因素;高中以上文化程度、有运动习惯、未接受手术为PTSD状况在T0到T1的保护因素,而ICU停留时间的增加为危险因素.结论 老年患者ICU后在认知、生理和心理方面整体上处于逐渐恢复的趋势,各领域症状的变化情况有不同的特点.

英文摘要:

      Objective To explore the longitudinal changes of symptoms related to post-intensive care unit(ICU)syn-drome in elderly patients and analyze their related influencing factors.Methods Time continuous sampling method was used to select elderly patients who were admitted to and transferred from three ICUs in a tertiary hospital in Shanghai from January 1 to December 31,2022.Their sociodemographic and clinical data were collected during ICU hospitalization.Nine scales or indica-tors,including Barthel Index(BI),Body Mass Index(BMI),grip,Pain score,Fatigue Severity Scale(FSS),Hospital Anx-iety and Depression Scale(HADS),Impact of Event Scale-Revised(IES-R),and Mini-Mental State Examination(MMSE)were used to assess symptoms of patients at 1 week(T0),1 month(T1),and 3 months(T2)after transferring from ICU.Results A total of 207 patients were included.Among the 9 indicators,the BI,grip and MMSE scores gradually increased over time.The value of BMI showed no significant change from T0 to T2.The pain score,depression score and anxiety score gradual-ly decreased over time.The fatigue score decreased slowly from the T0 to T1 stage,but rebounded from the T1 to T2 stage.The PTSD score increased from the T0 to T1 stage and decreased from the T1 to T2 stage.The analysis of influencing factors revealed that exercise habits and lack of surgery were protective factors for the FAS from T1 to T2,while increased ICU stay time,higher APACHE Ⅱ scores,mechanical ventilation,and comorbidities were risk factors.Education level above high school,exercise hab-its,and lack of surgery were protective factors for the IES-R from T0 to T1,while an increase in ICU stay time was a risk factor.Conclusion The elderly patients show an overall trend of progressive recovery trend in terms of cognitive,physical,and psycho-logical after ICU discharge,and the changes in symptom in various fields have different characteristics.