重症监护室后综合征对老年重症肺炎患者症状恢复及功能状态的影响

Influence of post-intensive care syndrome on symptom recovery and functional status in elderly patients with severe pneumonia

【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 采用系统抽样法选取2020年1月至2023年7月入住ICU并成功转出的155例老年重症肺炎患者为研究对象,进行问卷调查。共收回148例患者的有效问卷,问卷有效回收率95.48%。根据是否发生ICU后综合征,将患者分为ICU后综合征阳性组(69例)与阴性组(79例)。比较两组患者临床症状消失时间、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的百分比(PEF%)]及生活质量[简明健康状况调查问卷(SF-36)]差异。采用SPSS 24.0统计软件进行数据分析。根据数据类型,组间比较分别采用t检验或χ²检验。采用多因素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 两组患者退热时间以及咳嗽、咳痰、肺啰音消失时间比较,差异均无统计学意义(均P＞0.05)。两组患者年龄、ICU入住当日急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及ICU住院时长比较,差异均有统计学意义(均P＜0.05)。多因素logistic回归分析显示,年龄＞70岁(OR=2.373,95%CI 1.173～4.800)、ICU入住当日APACHEⅡ评分≥20分(OR=3.547,95%CI 2.123～5.925)、ICU住院时间≥10d(OR=2.992,95%CI 1.644～5.446)均为老年重症肺炎患者发生ICU后综合征的独立危险因素(P＜0.05)。阳性组ICU转出4周时FEV1、FVC、PEF%以及生理健康和心理健康各维度SF-36评分均低于阴性组,差异均有统计学意义(均P＜0.05)。结论 ICU后综合征可导致老年重症肺炎患者肺功能及生活质量下降。年龄较大、入住ICU时病情危重及ICU住院时间较长的患者ICU后综合征发生风险较高,临床应制定针对性的防控对策。

基金项目:江苏省卫生健康委员会科研项目(Z2021039)

【Abstract】Objective To analyze the influence of post-intensive care syndrome(PICS) on symptom recovery, functional status and quality of life in elderly patients with severe pneumonia. Methods Using a systematic sampling method, a questionnaire survey was conducted on 155 elderly patients with severe pneumonia who were admitted to the intensive care unit (ICU) and successfully transferred from January 2020 to July 2023. A total of 148 valid questionnaires were collected, with an effective recovery rate of 95.48%. According to whether post-ICU syndrome occurred or not, the patients were divided into PICS group (n=69) and non-PICS group (n=79). The two groups were compared in the duration of clinical symptoms, lung function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and percentage of peak expiratory flow to predicted value (PEF%)], and quality of life [short-form 36-item health status questionnaire (SF-36)] at 4 weeks after ICU transfer. SPSS 24.0 was used for data analysis. According to the data type, t test or Chi-square test was employed for comparison between groups. Multivariate logistic regression analysis was used to evaluate the risk factors of PICS in elderly patients with severe pneumonia. Results There were no statistically significant differences in duration of fever, cough, expectoration and lung rales between the two groups of the patients (all P>0.05). There were significant differences in age, scores on acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) on the day of admission to ICU and ICU stay between the two groups (P＜0.05 for all). Multivariate logistic regression analysis showed that age >70 years old (OR=2.373,95%CI 1.173-4.800; P<0.05), APACHEⅡ score ≥ 20 points on the day of admission to ICU (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 PICS in elderly patients with severe pneumonia (P<0.05). The FEV1, FVC, PEF%, and scores of physical health and mental health on SF-36 in the PICS group were lower than those in the non-PICS group at 4 weeks after ICU transfer (P<0.05 for all). Conclusion PICS can cause a decline in lung function and quality of life of patients with severe pneumonia. Patients with older age, critical illness on admission to ICU and longer ICU stay have a higher risk of PIUS, and it is clinically necessary to formulate targeted prevention and control measures.

This work was supported by Scientific Research Project of Jiangsu Provincial Health Commission (Z2021039).