ICU机械通气存活者长期结局及对ICU康复门诊看法的调查研究

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目的:调查分析重症监护病房(ICU)机械通气存活者长期结局及患者对设立ICU康复门诊的看法。方法:采用单中心横断面描述性研究设计,选择2016年1月至12月入住广州医科大学附属第一医院ICU的机械通气存活者为研究对象。2017年8月至2018年3月对研究对象进行随访,采用一般情况调查问卷、健康状况调查(SF-36)问卷、ICU康复门诊调查问卷对存活者的社会人口学资料、社会经济结局、临床资料、生活质量和对ICU康复门诊的看法进行调查。结果:本次调查共纳入248例ICU机械通气存活者,最终成功随访130例(52.4%),平均随访(19.64±3.20)个月。调查对象平均年龄(60.09±15.42)岁,60岁以上人群占55.4%。130例患者中,入ICU诊断以重症肺炎为主(占23.1%),其次为外科术后(心外科术后占16.9%、其他外科术后占20.8%)、肺移植(占13.1%)、慢性阻塞性肺疾病急性加重(AECOPD,占12.3%)等;首次急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)为(16.88±7.37)分;有创机械通气时间(12.52±12.34) d;ICU住院时间(16.71±15.11) d。在社会经济结局方面:至随访日,ICU存活者为全职/兼职的比例由入ICU前的32.3%(42/130)下降到25.4%(33/130),无业的比例由6.9%(9/130)增加至18.5%(24/130),仅有45.1%(23/51)的存活者重返之前的工作岗位;36.2%(47/130)的ICU存活者报告仍需要他人提供照护,86.9%(113/130)认为ICU治疗经历对其生活造成了影响。在生活质量方面:ICU存活者的生理职能维度得分最低、受损最严重,为(34.62±33.15)分;躯体疼痛维度、精神健康维度损伤较轻,得分分别为(90.19±16.98)分、(75.28±15.15)分。进一步归类,躯体健康总评(PCS)得分为(61.12±17.09)分,心理健康总评(MCS)得分为(65.97±21.85)分。在对ICU康复门诊的看法方面:68.5%(89/130)的调查对象认为设立ICU康复门诊是非常有益或有益的。结论:ICU机械通气存活者长期结局不容乐观,生活质量下降;设立ICU康复门诊是必要的。“,”Objective:To describe the long-term outcomes of intensive care unit (ICU) survivors of mechanical ventilation, and investigate the views of survivors on ICU rehabilitation clinics.Methods:A single-center cross-sectional descriptive study was designed. ICU survivors of mechanical ventilation admitted to the First Affiliated Hospital of Guangzhou Medical University from January to December 2016 were enrolled. Data were collected from August 2017 to March 2018. The general information questionnaire, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and ICU rehabilitation clinics questionnaire were used to evaluate ICU survivors social-demographic factors, social and economic outcomes, clinical data, quality of life and the views on ICU rehabilitation clinics.Results:A total of 248 ICU survivors of mechanical ventilation were included in the study, 130 (52.4%) of them were followed up successfully. The mean time from ICU discharge to follow-up day was (19.64±3.20) months. The average age of the survivors was (60.09±15.42) years old, and 55.4% of them were over 60 years old. Among 130 ICU survivors, severe pneumonia was the dominant ICU admission diagnosis (23.1%), followed by surgical operations (cardiac surgery 16.9%, other surgical operations 20.8%), lung transplantation (13.1%), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 12.3%), etc. The first APACHEⅡ score after ICU admission was 16.88±7.37, the mechanical ventilation time was (12.52±12.34) days, and the length of ICU stay was (16.71±15.11) days. In terms of social and economic outcomes, the proportion of having full-time or part-time jobs decreased from 32.3% (42/130) before ICU admission to 25.4% (33/130) by the date of follow-up, while the unemployed rate increased from 6.9% (9/130) to 18.5% (24/130). Only 45.1% (23/51) of the ICU survivors returned to the post before ICU admission. 36.2% (47/130) of the ICU survivors reported that they needed care from others, and 86.9% (113/130) reported that their treatment experiences in ICU had an impact on their lives. In terms of quality of life, physiological function dimension, which was 34.62±33.15, scored the lowest and suffered the most. The physical pain dimension and mental health dimension suffered the least, and the scores were 90.19±16.98 and 75.28±15.15, respectively. Furthermore, physical component summary (PCS) score was 61.12±17.09, and mental component summary (MCS) score was 65.97±21.85. In terms of the views of ICU rehabilitation clinics, 68.5% (89/130) of the subjects believed that the establishment of ICU rehabilitation clinics was very helpful or helpful.Conclusions:The long-term outcomes of ICU survivors of mechanical ventilation are not optimistic. Their quality of life is lower than that of general people. It is necessary to set up ICU rehabilitation clinics.
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