心脏手术后长时间重症监护对生活质量、恢复和临床结局的影响：一项前瞻性队列研究。
The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.
机构信息
Departments of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, St George's Hospital, London, United Kingdom.
Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
出版信息
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1906-1915.e3. doi: 10.1016/j.jtcvs.2018.05.076. Epub 2018 Jun 5.
OBJECTIVE
To examine the influence of prolonged intensive care unit (ICU) stay on quality of life and recovery following cardiac surgery.
METHODS
Quality of life was assessed using the Short Form 36 Health Survey (SF36). The Postoperative Quality of Recovery Scale was used to assess quality of recovery, disability, and cognition after ICU discharge over 12 months' follow-up. Prolonged ICU stay was defined as ≥3 postoperative days. Mortality and major adverse cardiac and cerebrovascular events were recorded up to 12 months.
RESULTS
For quality of life, the physical component improved over time in both groups (P < .01 for both groups), as did the mental component (P < .01 for both groups). The long ICU group had lower physical and mental components over time (both P values < .01), but by 12 months the values were similar. The overall quality of recovery was lower for the long ICU group (P < .01). Likewise, we found higher rates of recovery in the normal ICU group than in the long ICU group in terms of emotive recovery (P < .01), activities of daily living (P < .01), and cognitive recovery (P = .03) but no differences in terms of physiologic (P = .91), nociceptive (P = .89), and satisfaction with anesthetic care (P = .91). Major adverse cardiac and cerebrovascular events (P < .01), 30-day mortality (P < .01), and length of ward stay (P < .01) were all higher with prolonged ICU stay.
CONCLUSIONS
Patients with prolonged ICU stay have lower quality of life scores; however, they achieve similar midterm quality of recovery, but with reduced survival, increased major adverse cardiac and cerebrovascular events, and longer hospital length of stay.
目的
研究长时间重症监护病房（ICU）停留对心脏手术后生活质量和恢复的影响。
方法
采用健康调查简表 36 项（SF36）评估生活质量。采用术后恢复质量量表（Postoperative Quality of Recovery Scale）评估 ICU 出院后 12 个月内的恢复质量、残疾和认知。长时间 ICU 停留定义为术后≥3 天。记录 12 个月内的死亡率和主要心脏和脑血管不良事件。
结果
在两组中，身体成分随着时间的推移都有所改善（两组均 P < 0.01），心理成分也有所改善（两组均 P < 0.01）。长时间 ICU 组的身体和心理成分随着时间的推移逐渐降低（两组的 P 值均<0.01），但 12 个月后两组的数值相似。长时间 ICU 组的总体恢复质量较低（P < 0.01）。同样，我们发现长时间 ICU 组在情感恢复（P < 0.01）、日常生活活动（P < 0.01）和认知恢复（P = 0.03）方面的恢复率高于正常 ICU 组，而在生理（P = 0.91）、疼痛（P = 0.89）和麻醉护理满意度（P = 0.91）方面没有差异。长时间 ICU 停留与主要心脏和脑血管不良事件（P < 0.01）、30 天死亡率（P < 0.01）和住院时间（P < 0.01）增加有关。
结论
长时间 ICU 停留的患者生活质量评分较低；然而，他们在中期恢复质量相似，但生存率降低，主要心脏和脑血管不良事件增加，住院时间延长。
Zotero 插件