老年患者ICU获得性衰弱危险因素预测效能的临床研究  

Clinical Study of Predictive Value of Risk Factors for Intensive Care Unit-acquired Weakness in Critically Ill Elderly Patients

作　　者：杨涛[1] 席修明[2] Yang Tao;Xi Xiuming(Department of critical care medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070;Department of critical care medicine,Fu Xing Hospital,Capital Medical University,Beijing 100038)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070 [2]首都医科大学附属复兴医院重症医学科,北京100038

出　　处：《国际老年医学杂志》2024年第5期518-522,共5页International Journal of Geriatrics

基　　金：国家科技支撑计划课题(2012BAI11B00)。

摘　　要：目的探讨老年危重患者ICU获得性衰弱的危险因素,研究其在临床诊断中的预测价值。方法选取2017年6月—2018年10月首都医科大学附属复兴医院重症医学科收治的患者进行观察性队列研究,在患者清醒之日使用医学研究委员会评分进行肌力评估,根据临床肌力评估结果将患者分为试验组(肌力评分<48分)和对照组(≥48分)。收集和比较两组相关资料,采用多因素logistic回归分析评估老年危重患者ICU获得性衰弱发生的独立危险因素,采用ROC曲线评估各指标在老年患者ICU获得性衰弱发生中的预测价值。结果共收集62例清醒的老年危重患者,其中诊断为ICU获得性衰弱者30例为试验组(疾病发病率48.39%),无ICU获得性衰弱的32例为对照组。两组急性生理学和慢性健康状况评价(APACHE)Ⅱ评分、序贯器官衰竭评估评分、全身炎症反应综合征持续时间、脓毒症持续时间、脓毒症性休克、休克持续时间、多脏器功能障碍及其持续时间、机械通气持续时间、使用神经肌肉阻滞剂及其使用时间、使用去甲肾上腺素及其使用时间、低钙血症及电解质紊乱等指标比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,APACHEⅡ评分及去甲肾上腺素使用时间是老年危重患者ICU获得性衰弱发生的独立危险因素(P<0.05)。ROC曲线提示应用去甲肾上腺素>3 d和APACHEⅡ评分>20分为截断点时预测性能最佳。结论在老年危重患者中,APACHEⅡ评分和去甲肾上腺素使用时间是ICU获得性衰弱发生的独立危险因素和较好的预测指标。Objective To explore the predictive factors of ICU-acquired weakness in critically ill elderly patients and to investigate their predictive value in clinical diagnosis.Methods An observational cohort study was conducted on patients admitted to the department of critical care medicine at Beijing Fu xing Hospital Capital Medical University,from June 2017 to October 2018.Muscle strength was assessed using the medical research council score on the day the patients regained consciousness.Based on the clinical muscle strength assessment results,patients were divided into the experimental group(muscle strength score<48 scores)and the control group(≥48 scores).Relevant factors for both groups were collected and compared.Multivariate logistic regression analysis was used to assess the independent risk factors for ICU-acquired weakness in critically ill elderly patients.The predictive value of each indicator for ICU-acquired weakness on elderly patients was evaluated using ROC curves.Results A total of 62 awake elderly critically ill patients were collected.Among them,30 patients diagnosed with ICU-acquired weakness(prevalence rate of 48.39%)were designated as the experimental group,and 32 patients without ICU-acquired weakness were designated as the control group.Significant differences were found between the two groups in terms of acute physiology and chronic health evaluation(APACHE)Ⅱscores,sequential organ failure assessment scores,duration of systemic inflammatory response syndrome,duration of sepsis,septic shock,duration of shock,multiple organ dysfunction and its duration,use of norepinephrine and its duration,duration of mechanical ventilation,use of neuromuscular blocking agents and their duration,hypocalcemia,and electrolyte disturbances(P<0.05).Multivariate logistic regression analysis indicated that APACHEⅡscore and duration of norepinephrine use were independent risk factors for ICU-acquired weakness in elderly critically ill patients(P<0.05).The ROC curve suggested that the optimal predictive performanc

关 键 词：ICU获得性衰弱 危险因素 急性生理学和慢性健康状况评价Ⅱ评分 去甲肾上腺素 

分 类 号：R459.7[医药卫生—急诊医学]