重症监护病房脓毒症存活者生活质量现状及其影响因素分析  

Analysis of the current quality of life status and influencing factors of sepsis survivors in intensive care unit

作　　者：郝翠平 李秋华[2] 张翠翠[1] 张芬芬 张亚青[3] 朱丽娜 程焕焕 李英豪 胡庆河[1] Hao Cuiping;Li Qiuhua;Zhang Cuicui;Zhang Fenfen;Zhang Yaqing;Zhu Lina;Cheng Huanhuan;Li Yinghao;Hu Qinghe(Department of Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272030,Shandong,China;Department of Neurology,Affiliated Hospital of Jining Medical University,Jining 272030,Shandong,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Jining Medical University,Jining 272030,Shandong,China;School of Nursing,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong,China;Department of Rehabilitation Medicine,Affiliated Hospital of Jining Medical University,Jining 272030,Shandong,China)

机构地区：[1]济宁医学院附属医院重症医学科,山东济宁272030 [2]济宁医学院附属医院神经内科,山东济宁272030 [3]济宁医学院附属医院肝胆外科,山东济宁272030 [4]山东中医药大学护理学院,济南2250355 [5]济宁医学院附属医院康复医学科,山东济宁272030

出　　处：《中华危重病急救医学》2024年第1期23-27,共5页Chinese Critical Care Medicine

基　　金：山东省济宁市重点研发计划项目(2021JNZC016)。

摘　　要：目的探讨重症监护病房(ICU)脓毒症患者出院后生活质量现状及其影响因素,为临床早期心理干预及延续护理提供理论依据。方法采用前瞻性观察性研究方法,选择2022年1月1日至12月31日在济宁医学院附属医院重症医学科住院治疗并好转出院的脓毒症患者作为研究对象,记录所有患者的人口学信息、基础疾病、感染部位、入ICU时生命体征、入ICU 24 h内病情严重程度评分、实验室检查指标、治疗过程及预后指标等。在患者出院3个月时,通过问卷调查,使用36项简明健康调查量表(SF-36量表)、日常活动自理能力量表(ADL量表)和蒙特利尔认知评估量表(MoCA)进行评估。采用多元线性回归法分析脓毒症患者出院后生活质量的影响因素。结果最终有200例脓毒症患者经过治疗后好转出院,在出院3个月时进行随访,其中有150例完成调查问卷。150例患者中,脓毒症57例,脓毒性休克93例。所有患者出院3个月SF-36量表总分为(81.4±23.0)分,各维度评分从高到低依次为情感职能〔(83.4±23.0)分〕、心理健康〔(82.9±23.6)分〕、躯体疼痛〔(82.8±23.3)分〕、精力〔(81.6±23.2)分〕、生理功能〔(81.4±23.5)分〕、一般健康状况〔(81.1±23.3)分〕、生理职能〔(79.5±27.0)分〕和社会功能〔(78.8±25.2)分〕。脓毒症与脓毒性休克患者SF-36量表总分差异无统计学意义(分:82.6±22.0比80.7±23.6,P>0.05)。将线性单因素分析中有统计学意义的指标纳入多元线性回归分析,结果显示,脓毒症患者出院3个月生活质量影响因素包括出院3个月ADL量表评分〔β=0.741,95%可信区间(95%CI)为0.606~0.791,P<0.001〕、ICU住院时间(β=-0.209,95%CI为-0.733~-0.208,P=0.001)、机械通气时间(β=0.147,95%CI为0.122~0.978,P=0.012)、去甲肾上腺素总量(β=-0.111,95%CI为-0.044~-0.002,P=0.028)、入ICU时平均动脉压(MAP;β=-0.102,95%CI为-0.203~-0.007,P=0.036)和体质量(β=0.097,95%CI为0.005~0.345,P=0.044Objective To explore the current situation and influencing factors of quality of life of septic patients in intensive care unit(ICU)after discharge,and to provide theoretical basis for clinical early psychological intervention and continuity of care.Methods A prospective observational study was conducted.The septic patients who were hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University and discharged with improvement from January 1 to December 31,2022 were selected as the research objects.The demographic information,basic diseases,infection site,vital signs at ICU admission,severity scores of the condition within 24 hours after ICU admission,various biochemical indexes,treatment process,and prognostic indexes of all the patients were recorded.All patients were assessed by questionnaire at 3 months of discharge using the 36-item short-form health survey scale(SF-36 scale),the activities of daily living scale(ADL scale),and the Montreal cognitive assessment scale(MoCA scale).Multiple linear regression was used to analyze the factors influencing the quality of life of septic patients after discharge from the hospital.Results A total of 200 septic patients were discharged with improvement and followed up at 3 months of discharge,of which 150 completed the questionnaire.Of the 150 patients,57 had sepsis and 93 had septic shock.The total SF-36 scale score of septic patients at 3 months of discharge was 81.4±23.0,and the scores of dimensions were,in descending order,role-emotional(83.4±23.0),mental health(82.9±23.6),bodily pain(82.8±23.3),vitality(81.6±23.2),physical function(81.4±23.5),general health(81.1±23.3),role-physical(79.5±27.0),and social function(78.8±25.2).There was no statistically significant difference in the total SF-36 scale score between the patients with sepsis and septic shock(82.6±22.0 vs.80.7±23.6,P>0.05).Incorporating the statistically significant indicators from linear univariate analysis into multiple linear regression analysis

关 键 词：重症监护病房 脓毒症 生活质量 认知功能障碍 

分 类 号：R459.7[医药卫生—急诊医学]