严重创伤患者发生重症监护后综合征危险因素的meta分析  

Meta-analysis of risk factors for post-intensive care syndrome in severely traumatized patients

作　　者：孙翠玲 陈春丽[1] 孙云云[2] 潘小娜 朱鹏程 秦文娇 SUN Cuiling;CHEN Chuni;SUN Yunyun;PAN Xiaona;ZHU Pengcheng;QIN Wenjiao(Department of Nursing,the Second People’s Hospital of Hefei,Anhui Province,Hefei 230011,China;Department of Anesthesiology,the Second People’sHospital of Hefei,Anhui Province,Hefei 230011,China;School of Nursing,Anhui University of Chinese Medicine,Anhui Province,Hefei 230012,China;School of Nursing,Bengbu Medical University,Anhui Province,Bengbu 233030,China)

机构地区：[1]合肥市第二人民医院护理部,安徽合肥230011 [2]合肥市第二人民医院麻醉科,安徽合肥230011 [3]安徽中医药大学护理学院,安徽合肥230012 [4]蚌埠医科大学护理学院,安徽蚌埠233030

出　　处：《中国医药导报》2024年第23期186-191,共6页China Medical Herald

基　　金：中国红十字基金会医学赋能公益专项基金“医学赋能及人才培养计划”临床科研项目(CRCF-YXFN-202201063);蚌埠医学院研究生科研创新计划资助立项项目(Byycx23019)。

摘　　要：目的系统评价严重创伤患者发重症监护后综合征(PICS)的危险因素。方法计算机检索PubMed、Medline、Web of Science、CochraneLibrary、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库中关于严重创伤患者发生PICS危险因素的相关文献,检索时间限定为2010年1月至2024年4月。由2名研究者独立进行文献的筛选与数据提取,采用纽卡斯尔-渥太华量表(NOS)对纳入的队列研究和病例对照研究进行文献质量评价,横断面研究则参照美国卫生保健和质量机构(AHRQ)的标准进行文献质量评价,采用RevMan 5.4和Stata18.0软件进行meta分析。结果共纳入11篇文献,其中7篇为横断面研究,4篇为病例对照研究,文献质量均为中高等。meta分析结果显示,年龄≥60岁(OR=1.66,95%CI:1.43~1.91,P<0.001)、吸烟(OR=5.45,95%CI:1.61~18.47,P=0.006)、饮酒(OR=6.90,95%CI:2.14~22.26,P=0.001)、入住ICU时长≥7 d(OR=2.45,95%CI:1.18~5.11,P=0.020)、机械通气治疗(OR=1.96,95%CI:1.04~3.68,P=0.040)、睡眠障碍(OR=2.78,95%CI:1.35~5.73,P=0.005)、镇静药物使用(OR=2.88,95%CI:1.34~6.22,P=0.007)是严重创伤患者发生PICS的独立危险因素。敏感性和发表偏倚分析结果显示,除年龄≥60岁和入住ICU时长≥7 d因素外,其他因素均提示分析结果可靠,存在发表偏倚可能较小。结论严重创伤患者发生ICU后综合征的危险因素众多,临床实践中医护人员应重点关注其高危人群,并对这些风险因素进行及时的评估和干预,以降低重症创伤患者ICU后综合征的发生率,更好地促进患者健康转归。Objective To systematically review the risk factors for post-intensive care syndrome(PICS)in severely traumatized patients.Methods PubMed,Medline,Web of Science,Cochrane Library,CNKI,Wanfang Data,VIP,and China Biomedical Literature Database were searched to collect relevant literatures on the risk factors for PICS syndrome in severely traumatized patients.The retrieval period was from January 2010 to April 2024.Literature screening and data extraction were performed independently by two investigators.Literature quality was evaluated using the Newcastle-Ottawa scale(NOS)for included cohort and case-control studies,and the agency for healthcare and quality(AHRQ)criteria for cross-sectional studies,and meta-analyses were performed using the RevMan 5.4 and Stata 18.0 software.Results A total of 11 literatures were included,seven of them were cross-sectional studies and four were case-control studies,all of which were of moderate to high quality.Meta-analysis results showed that age≥60 years(OR=1.66,95%CI:1.43-1.91,P<0.001),smoking(OR=5.45,95%CI:1.61-18.47,P=0.006),alcohol consumption(OR=6.90,95%CI:2.14-22.26,P=0.001),length of stay in the ICU≥7 days(OR=2.45,95%CI:1.18-5.11,P=0.020),mechanical ventilation therapy(OR=1.96,95%CI:1.04-3.68,P=0.040),sleep disorders(OR=2.78,95%CI:1.35-5.73,P=0.005),sedative medication use(OR=2.88,95%CI:1.34-6.22,P=0.007)were independent risk factors for PICS syndrome in severely traumatized patients.The results of sensitivity and publication bias analyses showed that,except for the factors of age≥60 years and length of stay in the ICU≥7 days,the other factors suggested that the results of the analyses were reliable,and the presence of publication bias was less likely.Conclusion There are numerous risk factors for the occurrence of post-ICU syndrome in severely traumatized patients,and in clinical practice healthcare professionals should focus on their high-risk groups and provide timely assessment and intervention for these risk factors in order to reduce the incidence of post-ICU

关 键 词：创伤 危重症 重症监护后综合征 危险因素 META分析 

分 类 号：R47[医药卫生—护理学]