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危重症 COVID-19 患者的急性功能转归

Acute Functional Outcomes in Critically Ill COVID-19 Patients.

作者信息

Tay Matthew Rong Jie, Ong Poo Lee, Puah Ser Hon, Tham Shuen Loong

机构信息

Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore.

Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.

出版信息

Front Med (Lausanne). 2021 Jan 18;7:615997. doi: 10.3389/fmed.2020.615997. eCollection 2020.

Abstract

COVID-19 (Coronavirus Disease 2019) is a global cause of morbidity and mortality currently. We aim to describe the acute functional outcomes of critically ill coronavirus disease 2019 (COVID-19) patients after transferring out of the intensive care unit (ICU). 51 consecutive critically ill COVID-19 patients at a national designated center for COVID-19 were included in this exploratory, retrospective observational cohort study from January 1 to May 31, 2020. Demographic and clinical data were collected and analyzed. Functional outcomes were measured primarily with the Functional Ambulation Category (FAC), and divided into 2 categories: dependent ambulators (FAC 0-3) and independent ambulators (FAC 4-5). Multivariate analysis was performed to determine associations. Many patients were dependent ambulators (47.1%) upon transferring out of ICU, although 92.2% regained independent ambulation at discharge. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (odds ratio 14.02, 95% CI 1.15-171.28, = 0.039) and a longer length of ICU stay (odds ratio 1.50, 95% CI 1.04-2.16, = 0.029) were associated with dependent ambulation upon discharge from ICU. Critically ill COVID-19 survivors have a high level of impairment following discharge from ICU. Such patients should be screened for impairment and managed appropriately by rehabilitation professionals, so as to achieve good functional outcomes on discharge.

摘要

2019冠状病毒病(COVID-19)是当前全球发病和死亡的一个原因。我们旨在描述危重症2019冠状病毒病(COVID-19)患者转出重症监护病房(ICU)后的急性功能转归。本探索性、回顾性观察队列研究纳入了2020年1月1日至5月31日期间在一家国家指定的COVID-19中心连续收治的51例危重症COVID-19患者。收集并分析了人口统计学和临床数据。主要采用功能步行分类(FAC)来衡量功能转归,并分为两类:依赖步行者(FAC 0-3)和独立步行者(FAC 4-5)。进行多变量分析以确定相关性。许多患者转出ICU时为依赖步行者(47.1%),不过92.2%的患者出院时恢复了独立步行能力。多变量分析显示,查尔森合并症指数为1或更高(比值比14.02,95%可信区间1.15-171.28,P = 0.039)以及ICU住院时间较长(比值比1.50,95%可信区间1.04-2.16,P = 0.029)与出院时依赖步行相关。危重症COVID-19幸存者在从ICU出院后存在高度功能障碍。此类患者应接受功能障碍筛查,并由康复专业人员进行适当管理,以便出院时获得良好的功能转归。

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