摘要
目的:探讨成人重症监护病房(ICU)幸存者重症监护室后综合征(PICS)的发生现状,为临床医务人开展预防及干预提供参考。方法:计算机检索EMbase、Web of Science、PubMed、the Cochrane Library、中国生物医学文献服务系统、万方数据库、中国知网、维普数据库,查找已发表的有关PICS发生率的研究,检索时限为建库至2022年5月。由2名研究者按照纳入和排除标准独立筛选文献、提取资料及评价文献方法学质量,采用Stata 14.0软件进行Meta分析。结果:纳入15项研究,涵盖7个国家,成功随访ICU幸存者4607例。15项研究报告PICS总体发生率为24.8%~100.0%;Meta分析合并PICS发生率为64%[95%CI(0.55,0.73)],其中认知障碍的发病率为2%~56%,合并结果为23%[95%CI(0.13,0.36)],心理障碍的发病率为9%~61%,合并结果为30%[95%CI(0.21,0.39)],生理障碍的发病率为18%~96%,合并结果为49%[95%CI(0.38,0.60)]。进行亚组分析,结果显示,外科ICU病人、使用评估工具>3个、评估方式为面对面访谈的研究PICS发生率较高。结论:现有证据表明,PICS的发生率较高,其中生理障碍最常见,应予以足够重视;由于PICS诊断机制复杂,评估工具不统一,PICS发生率有待进一步在大样本、多中心人群中验证;未来研究应开发PICS评估的高特异性和高敏感性的工具。
Objective:To investigate the status of post-intensive care syndrome(PICS)in adult intensive care unit(ICU)survivors,and to provide scientific evidence for related control and prevention work.Methods:The studies on the incidence of PICS were retrieved from PubMed,EMbase,the Cochrane Library,Web of Science,SinoMed,CNKI,VIP and WanFang Database.The retrieval time was from the inception to May 2022.Two researchers independently screened literature according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies.Then,Meta-analysis was performed by using the Stata 14.0 software.Results:15 studies were included,covering 7 countries.4607 ICU survivors were successfully followed up.The overall incidence of PICS was 24.8%-100.0%in 15 studies.The incidence of Meta-analysis combined with PICS was 64%[95%CI(0.55,0.73)],of which the incidence of cognitive impairment was 2%-56%,the incidence of combined results was 23%[95%CI(0.13,0.36)],and the incidence of psychological disorders was 9%-61%.The combined outcome was 30%[95%CI(0.21,0.39)],the incidence of physical disorders was 18%-96%,and the combined outcome was 49%[95%CI(0.38,0.60)].Subgroup analysis showed a higher incidence of PICS among surgical ICU patients,those in Europe and the United States,those using>3 assessment tools,and those using face-to-face interviews.Conclusion:Current envidence shows that the incidence of PICS is high,and physiological disorders are the most common,which should be paid more attention to.Due to the complex diagnostic mechanism of PICS,inconsistent assessment tools,and strong heterogeneity of existing studies,the incidence of PICS needs to be further verified in large sample,multi-center population.Comprehensive and effective assessment has the potential to improve the detection rate of PICS,and future research should focus on developing highly specific and sensitive tools for PICS assessment.
作者
游琳琳
江智霞
周静
胥露
鲁鑫
张习莹
YOU Linlin;JIANG Zhixia;Zhou Jing;XU Lu;LU Xin;ZHANG Xiying(The Second Affiliated Hospital of Zunyi Medical University,Guizhou 550000 China)
出处
《循证护理》
2023年第15期2677-2684,共8页
Chinese Evidence-Based Nursing
基金
贵州护理职业技术学院院级课题,编号:gzhlyj2022-1。
关键词
危重症
重症监护室后综合征
META分析
发生率
循证护理
critical illness
post-intensive care syndrome
Meta-analysis
incidence
evidence-based nursing
