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重症监护后综合征:其病理生理学、预防及未来方向。

Post-intensive care syndrome: its pathophysiology, prevention, and future directions.

作者信息

Inoue Shigeaki, Hatakeyama Junji, Kondo Yutaka, Hifumi Toru, Sakuramoto Hideaki, Kawasaki Tatsuya, Taito Shunsuke, Nakamura Kensuke, Unoki Takeshi, Kawai Yusuke, Kenmotsu Yuji, Saito Masafumi, Yamakawa Kazuma, Nishida Osamu

机构信息

Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan.

Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan.

出版信息

Acute Med Surg. 2019 Apr 25;6(3):233-246. doi: 10.1002/ams2.415. eCollection 2019 Jul.

Abstract

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

摘要

在全球发达国家,老年人口不断增加是一项重大社会挑战,这导致重症监护病房(ICU)中老年患者数量迅速上升。医疗技术的创新进步使ICU患者得以挽救生命,但在改善其长期预后方面仍存在各种问题。重症监护后综合征(PICS)是指在ICU住院期间、ICU出院后或医院出院后出现的身体、认知和精神障碍,以及ICU患者的长期预后情况。其概念也适用于儿科患者(PICS-p)及其家庭的精神状态(PICS-F)。重症监护病房获得性肌无力是一种以ICU入院后急性对称性肢体肌肉无力为特征的综合征,属于PICS三个领域中的身体障碍。预防PICS需要实施ABCDEFGH集束化方案,该方案从ICU入院到出院期间纳入了谵妄预防、早期康复、家庭干预和随访。日记、营养、护理和促进康复的环境管理在预防PICS方面也很重要。本综述概述了PICS的病理生理学、预防措施及未来发展方向。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f3bf/6603316/ea71c949c83c/AMS2-6-233-g001.jpg

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