ICU后综合征对老年重症肺炎患者症状恢复、功能状态和生活质量的影响

【摘要】摘要 目的 分析重症监护室(ICU)后综合征对老年重症肺炎患者症状恢复、功能状态和生活质量的影响。方法 采用系统抽样法对2020年1月～2023年7月入住ICU并成功转出的155例老年重症肺炎患者行问卷调查，在ICU转出当日及转出后4周通过评估认知、心理、生理功能是否加重判断ICU后综合征发生情况，并以此分为ICU后综合征阳性组与阴性组，比较两组临床症状消失时间及ICU转出后4周时肺功能[第一秒用力呼气量(FEV1)、用力肺活量(FVC)、呼气峰流速占预计值比(PEF%)]、生活质量[健康状况问卷量表(SF-36)]差异，使用SPSS 24.0软件分析数据，计数数据采用χ2检验，均数数据使用t检验，使用Logistic回归分析评估老年重症肺炎患者发生ICU后综合征的危险因素。结果 155例老年重症肺炎患者共收回148例患者的有效问卷，有效回收率95.48%，其中ICU后综合征阳性组69例，阴性组79例。两组老年重症肺炎患者退热时间及咳嗽、咳痰、肺啰音消失时间比较，差异无统计学意义（P＞0.05）。Logistic回归方程，结果显示，年龄＞70岁[OR=2.373，95%CI（1.173～4.800），P＜0.05]、ICU入住当日APACHEⅡ评分≥20分[OR=3.547，95%CI（2.123～5.925），P＜0.05]、ICU住院时长≥10d[OR=2.992，95%CI（1.644～5.446），P＜0.05]均为老年重症肺炎患者发生ICU后综合征的危险因素。阳性组ICU转出4周时FEV1、FVC、PEF%、生理健康及心理健康各维度SF-36评分均低于阴性组（P＜0.05）。结论 年龄较大、入住ICU时病情危重、ICU住院时间较长的老年重症肺炎患者ICU后综合征发生风险较高，ICU后综合征可造成患者肺功能及生活质量下降，临床应制定防控对策。

基金项目:江苏省卫生健康委员会科研项目(Z2021039)

【Abstract】Abstract Objective To analyze the influence of post-intensive care unit (ICU) syndrome on symptom recovery, functional status and quality of life in elderly patients with severe pneumonia. Methods A questionnaire survey was conducted on 155 elderly patients with severe pneumonia who were admitted to ICU and successfully transferred from January 2020 to July 2023 by systematic sampling method. On the day of ICU transfer and at 4 weeks after ICU transfer, the occurrence of post-ICU syndrome was judged by evaluating whether the cognitive, psychological and physiological functions were aggravated, and the patients were divided into post-ICU syndrome positive group and negative group. The disappearance times of clinical symptoms and lung function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEF%)] and quality of life [Short-Form 36-item Health Status Questionnaire (SF-36)] at 4 weeks after ICU transfer were compared between the two groups. SPSS 24.0 software was used for data analysis, and enumeration data were analyzed by chi-square test, and mean data were detected by t test. Logistic regression analysis was applied to evaluate the risk factors of post-ICU syndrome in elderly patients with severe pneumonia. Results 148 effective questionnaires were collected from 155 elderly patients with severe pneumonia, with an effective recovery rate of 95.48%. There were 69 cases in post-ICU syndrome positive group and 79 cases in negative group. There were no statistical differences in the fever abatement time and the disappearance times of cough, expectoration and lung rales between the two groups of elderly patients with severe pneumonia (P>0.05). Logistic regression equation showed that age>70 years old [OR=2.373, 95%CI (1.173-4.800), P<0.05], APACHE II score≥ 20 points on the day of ICU admission [OR=3.547, 95%CI (2.123-5.925), P<0.05], and ICU stay≥10 d [OR=2.992, 95%CI (1.644-5.446), P<0.05] were risk factors of post-ICU syndrome in elderly patients with severe pneumonia. The FEV1, FVC, PEF%, and scores of physical health and mental health of SF-36 in positive group were lower than those in negative group at 4 weeks after ICU transfer (P<0.05). Conclusion The risk of post-ICU syndrome is high in elderly patients with severe pneumonia who are older, critically ill when admitted to ICU, and have longer ICU stay. Post-ICU syndrome can cause a decline in lung function and quality of life of patients, and it is necessary to formulate clinical prevention and control measures.