重症监护后综合征患者的干预研究进展

doi:10.16460/j.issn1008-9969.2023.21.029

摘要/Abstract

摘要： 目的综述重症监护后综合征患者（post-intensive care syndrome, PICS）的干预管理策略,为形成统一、规范、安全的管理方案和促进临床深入实践提供借鉴。方法结合国内外文献,对PICS的管理进行探讨,分析并总结其概述、疾病负担、干预实施者和干预对象、干预时间及场所、干预内容、干预效果评价等。结果 ICU阶段的干预主要是预防性干预。干预时机、场所、效果评价指标等没有统一的标准。ICU后干预报道较少,ICU内的干预效果未能高质量的延续至病房及家庭/社区。结论重症监护后综合征患者的管理普遍存在重ICU内、轻ICU后,重院内、轻院外及重预防、轻康复等问题。未来的工作应侧重于研究现有干预措施对患者预后的影响,探索具有潜在益处的新干预措施,并确定最有效的ICU后护理模式,以患者和家属为中心,建立起一个从ICU到社区或基层医疗的连续护理体系,实现筛查、治疗、康复闭环管理路径,将精准干预与全程照护相结合,针对性、阶段性实施干预管理,逐渐形成重症监护后综合征患者全过程、全周期健康管理模式。

关键词: 重症监护后综合征, 干预, 数字化护理, 全程照护, 综述

中图分类号:

R473

刘小会, 高绘明, 钟明利, 李丽, 李丝静, 辜甜田, 胡汝均. 重症监护后综合征患者的干预研究进展[J]. 护理学报, 2023, 30(21): 29-33.

参考文献

[1] Rousseau AF, Prescott HC, Brett SJ, et al.Long-term outcomes after critical illness: recent insights[J]. Crit Care, 2021, 25(1): 1-7. DOI: 10.1186/s13054-021-03535-3.
[2] 陈名桂,侯春怡,王芳芳,等. 预防ICU患者获得性衰弱最佳早期活动策略的循证护理实践[J]. 护理学报,2019,26(23):45-49. DOI: 10.16460/j.issn1008-9969.2019.23.045.
[3] 游琳琳,江智霞,袁晓丽,等.重症监护后综合征评估的研究新进展[J].中华危重病急救医学,2022,34(10):1116-1120. DOI: 10.3760/cma.j.cn121430-20220317-00254.
[4] Danesh V, Hecht J, Hao R, et al.Peer support for post intensive care syndrome self‐management (PS-PICS): study protocol for peer mentor training[J]. J Adv Nurs, 2021, 77(4): 2092-2101. DOI: 10.1111/jan.14736.
[5] Connolly B, Douiri A, Steier J, et al.A UK survey of rehabilitation following critical illness: implementation of NICE Clinical Guidance 83 (CG83) following hospital discharge[J]. BMJ Open, 2014,4(5):e004963.DOI:10.1136/bmjopen-2014-004963.
[6] Besnier E, Bounes F, Cinotti R, et al.Diagnosis and management of post intensive care syndrome in France: a survey from the French national society of anaesthesia and intensive care[J]. Anaesth Crit Care Pain Med,2023,42(4):101237-101240. DOI: 10.1016/j.accpm.2023.101237.
[7] Vincent A, Beck K, Thommen E, et al.Post-intensive care syndrome in out-of-hospital cardiac arrest patients: A prospective observational cohort study[J]. PLoS One, 2022, 17(10): 1-17. DOI: 10.1371/journal.pone.0276011.
[8] Carel D, Pantet O, Ramelet AS, et al.Post intensive care syndrome (PICS) physical, cognitive, and mental health outcomes 6-months to 7 years after a major burn injury: a cross-sectional study[J]. Burns, 2023, 49(1): 26-33. DOI: 10.1016/j.burns.2022.10.004.
[9] Kawakami D, Fujitani S, Morimoto T, et al.Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study[J]. Crit Care,2021,25(1):1-12.DOI: 10.1186/s13054-021-03501-z.
[10] Zhou M, Zhang J, Xu Z, et al.Incidence of and risk factors for post-intensive care syndrome among Chinese respiratory intensive care unit patients: a cross-sectional, prospective study[J].Aust Crit Care,2023,36(4):464-469.DOI: 10.1016/j.aucc.2022.07.005.
[11] 王颖,江智霞,胥露,等. 基于BP神经网络的ICU后综合征预测模型构建研究[J].中国护理管理, 2021, 21(12):1856-1860. DOI: 10.3969/j.issn.1672-1756.2021.12.021.
[12] Daniels LM, Johnson AB, Cornelius PJ, et al.Improving quality of life in patients at risk for post-intensive care syndrome[J]. Mayo Clin Proc Innov Qual Outcomes, 2018, 2(4): 359-369. DOI: 10.1016/j.mayocpiqo.2018.10.001.
[13] 何敏,江智霞,何兴松,等. 基于利益相关者理论的ICU后综合征全程管理模式探讨[J].护理研究,2021,35(9):1532-1538. DOI: 10.12102/j.issn.1009-6493.2021.09.006.
[14] Berger P, Braude D.Post-intensive care syndrome: screening and management in primary care[J].Aust J Gen Pract, 2021, 50(10):737-740. DOI:10.31128/ajgp-07-20-55492.
[15] 中华人民共和国中央人民政府.中共中央国务院印发《关于进一步完善医疗卫生服务体系的意见》[EB/OL].(2023-03-23)[2023-08-21].http://www.gov.cn/zhengce/2023-03/23/content-5748063.htm.
[16] Lee H, Ryu K, Sohn Y, et al.Impact on patient outcomes of pharmacist participation in multidisciplinary critical care teams: a systematic review and Meta-analysis[J]. Crit Care Med,2019, 47(9):1243-1250.DOI:10.1097/ccm.0000000000003830.
[17] Philbrick K, Bieber E, Karnatovskaia L.Can we pick the pocket of post-intensive care syndrome?[J].European Psychiatry,2022,65(S1):S680-S680.DOI:10.1192/j.eurpsy.2022.1749.
[18] 邓露茜,沈艳,刁玲玲,等. 以家庭为中心的共享决策对患者及其照顾者ICU后综合征的影响[J]. 现代临床护理, 2023,22(5):49-56. DOI:10.3969/j.issn.1671-8283.2023.05.008.
[19] Denehy L, Berney S, Skinner E, et al.Evaluation of exercise rehabilitation for survivors of intensive care: protocol for a single blind randomised controlled trial[J]. Open Crit Care Med J,2008,1(1):39-47.DOI:10.2174/1874828700801010039.
[20] NICE. Rehabilitation after critical illness[EB/OL].[2023-04-10].http:// www.nice.org.uk/CG83.
[21] Elliott D, Davidson JE, Harvey MA, et al.Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting[J]. Crit Care Med, 2014, 42(12):2518-2526. DOI: 10.1097/CCM.0000000000000525.
[22] NICE. Rehabilitation after critical illness in adults NICE Clinical guideline(CG83)[EB/OL].[2023-04-10].https://www.nice.org.uk/guidance/CG83/chapter/introduction.2017.
[23] Liu XH, Long J, Chang Y, et al.Application of the whole-course care model (IWF/C Care) for postintensive care syndrome based on an early warning system in critically ill patients: a randomised controlled trial study protocol[J]. BMJ Open, 2023, 13(7): e073035. DOI: 10.1136/bmjopen-2023-073035.
[24] Renner C, Jeitziner MM, Albert M, et al.Guideline on multimodal rehabilitation for patients with post-intensive care syndrome[J]. Crit care, 2023, 27(1):1-14. DOI:10.1186/s13054-023-04569-5.
[25] Kumar A, Netzer G, Shah N.822: Efficacy of post-discharge educational materials on post-intensive care syndrome[J]. Crit Care Med, 2020, 48(1):391. DOI:10.1097/01.ccm.0000631428.74666.91.
[26] Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, et al.Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study[J].Crit Care, 2021, 25(1):1-15.DOI:10.1186/s13054-021-03709-z.
[27] 梁诗雨,张宇翔,邵乐文,等. 基于多学科团队的IC U后门诊的研究进展[J]. 护理研究,2023,37(7):1222-1227.DOI: 10.12102/j.issn.1009-6493.2023.07.019.
[28] 万娜,常鑫儿,张春艳,等.ICU后门诊的建立与运行实践[J].中国护理管理,2021,21(4):566-569.DOI:10.3969/j.issn.1672-1756.2021.04.019.
[29] Torbic H, Conroy G, Ward J, et al.853: Pharmacist interventions in a post-intensive care unit recovery clinic[J]. Crit Care Med,2022,50(1):421.DOI:10.1097/01.ccm.0000809736.02922.d8.
[30] Taylor B, Lizza B, Betthauser K, et al.100: Feasibility of a multidisciplinary covid-19 virtual post-intensive care syndrome clinic (cov-pics)[J]. Crit Care Med, 2022, 50(1): 33. DOI: 10.1097/01.ccm.0000806724.99251.31.
[31] 廉洁, 李玉静, 杜金磊, 等. ICU后综合征患者于普通病房内功能锻炼的研究现状[J].中西医结合护理(中英文),2020,6(10):453-456. DOI:10.11997/nitcwm.202010114.
[32] Battle CW, Pieber K, Steiner I, et al.Can early rehabilitation on the general ward after an intensive care unit stay reduce hospital length of stay in survivors of critical illness?: a randomized controlled trial[J]. Am J Phys Med Rehabil,2017, 96(9):607-615.DOI:10.1097/PHM.0000000000000718.
[33] Battle C, James K, Temblett P, et al.Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial[J]. J Intensive Care Soc, 2019, 20(1):18-26. DOI:10.1177/1751143718767061.
[34] 李晨曦,尚云峰,王丽云,等. 计算机认知训练对轻度认知障碍老年人认知功能的影响研究[J].中华护理杂志,2021,56(5):667-673.DOI:10.3761/j.issn.0254-1769.2021.05.004.
[35] Navarra-Ventura G, Gomà G, de Haro C, et al. Virtual reality-based early neurocognitive stimulation in critically ill patients: a pilot randomized clinical trial[J]. J Pers Med, 2021, 11(12):1260-1274. DOI:10.3390/jpm11121260.
[36] Blair GJ, Kapil S, Cole SP, et al.Virtual reality use in adult ICU to mitigate anxiety for a patient on VV ECMO[J]. J Clin Anesth, 2019,55:26-27.DOI:10.1016/j.jclinane.2018.12.033.
[37] Vlake JH, van Bommel J, Wils EJ, et al. Intensive care Unit-Specific virtual reality for critically ill patients with COVID-19: multicenter randomized controlled trial[J]. J Med Internet Res, 2022, 24(1): 1-16. DOI: 10.2196/32368.
[38] Turan Z, Topaloglu M, Ozyemisci TO.Is tele-rehabilitation superior to home exercise program in COVID-19 survivors following discharge from intensive care unit?-a study protocol of a randomized controlled trial[J].Physiother Res Int, 2021, 26(4): e1920-e1929. DOI:10.1002/pri.1920.
[39] Atashzar SF, Carriere J, Tavakoli M.How can intelligent robots and smart mechatronic modules facilitate remote assessment, assistance, and rehabilitation for isolated adults with neuro-musculoskeletal conditions?[J].Front Robot AI, 2021, 8:1-19. DOI:10.3389/frobt.2021.610529.
[40] Atashzar SF, Shahbazi M, Patel RV.Haptics-enabled interactive neurorehabilitation mechatronics: classification, functionality, challenges and ongoing research[J]. Mechatronics, 2019, 57: 1-19. DOI:10.1016/j.mechatronics.2018.03.002.
[41] Ferre M, Batista E, Solanas A, et al.Smart health-enhanced early mobilisation in intensive care units[J]. Sensors, 2021, 21(16): 5408-5425. DOI: 10.3390/s21165408.
[42] Turon M, Fernandez-Gonzalo S, Jodar M, et al.Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients[J]. Ann Intensive Care, 2017, 7: 1-11. DOI: 10.1186/s13613-017-0303-4.
[43] Liu C, Liu YX,Qiu DS. Follow-up visit method and system for post-ICU syndrome: CN113035296A[P/OL].2021-06-25.https://worldwide.espacenet.com/patent/search?q=pn%3DCN113035296A.
[44] Eaton TL, Scheunemann LP, Butcher BW, et al.The prevalence of spiritual and social support needs and their association with postintensive care syndrome symptoms among critical illness survivors seen in a post-ICU follow-up clinic[J]. Crit Care Explor, 2022, 4(4):1-12. DOI: 10.1097/CCE.0000000000000676.
[45] Obanor OO, McBroom MM, Elia JM, et al. The impact of earplugs and eye masks on sleep quality in surgical ICU patients at risk for frequent awakenings[J]. Crit Care Med, 2021,49(9):e822-e832.DOI:10.1097/CCM.0000000000005031.

Metrics

Viewed

Full text

Abstract

Cited

Shared