目的:对重型胸部损伤患者ICU获得性衰弱(Intensive Care Unit Acquired Weakness,ICU-AW)风险因素进行量化,为早期识别、预防ICU-AW提供理论依据.方法:采用便利抽样法,选取某三级甲等医院胸腔外科ICU重型胸部损伤患者180 例作为研究对象,采用一般资料调查表和ICU-AW危险因素采集表收集患者相关资料,通过二元Logistic回归分析筛选出ICU-AW的危险因素.结果:73 例(40.56%)患者并发ICU-AW;二元Logistic回归分析结果显示,年龄大、APACHEⅡ评分高、存在多器官功能衰竭、机械通气时间长、活动受限、使用糖皮质激素、乳酸水平高为重型胸部损伤患者ICU-AW的危险因素(P<0.05).结论:重型胸部损伤患者ICU-AW发生率较高且影响因素复杂,临床医务人员应加强对老年患者的关注,及时对入住ICU患者进行APACHEⅡ评分,注意对多器官功能衰竭患者的识别,根据患者胸部创伤严重程度制定个体化机械通气方案,密切关注长期大量使用糖皮质激素患者全身症状及肌力变化情况,关注患者血乳酸水平,预防重型胸部损伤患者ICU-AW的发生,从而提高重型胸部损伤患者的护理管理质量.
Status and risk factors of ICU Acquired Weakness in patients with severe chest injury
Objective:To quantify the risk factors for Intensive Care Unit Acquired Weakness(ICU-AW)among patients with severe chest injury,so as to provide theoretical basis for early identification and prevention of ICU-AW.Methods:By convenient sampling method,180 patients with severe chest injury in the department of thoracic surgery ICU of a tertiary grade A hospital were recruited.Relevant data of patients were collected by patient general data questionnaire and risk factor collection table.The risk factors of ICU-AW were obtained by Logistic regression analysis.Results:Seventy three patients were complicated with ICU-AW,and the incidence of ICU-AW was 40.56%.Binary Logistic regression analysis results showed that:older age,high APACHE Ⅱ score,multiple organ dysfunction syndrome,more mechanical ventilation time,activity restriction,the use of glucocorticoids,and the high level of blood lactic acid were risk factors for ICU-AW in patients with severe chest injury(P<0.05).Conclusion:The incidence of ICU-AW is high and the risk factors are complex in patients with severe chest injury.Clinical medical staff should pay more attention to elderly patients,conduct APACHEⅡ scoring of patients admitted to ICU in time,identify patients with multiple organ dysfunction syndrome,develop individualized mechanical ventilation plan according to the severity of the patient's chest trauma,closely monitor the systemic symptoms and muscle strength changes in patients with long-term heavy use of glucocorticoid,and monitor the level of blood lactic acid of patients,thereby preventing the occurrence of ICU-AW in patients with severe chest injury,and ultimately improving the quality of nursing management of patients with severe chest injury.
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