Watanabe Shinichi, Liu Keibun, Nakamura Kensuke, Kozu Ryo, Horibe Tatsuya, Ishii Kenzo, Yasumura Daisetsu, Takahashi You, Nanba Tomoya, Morita Yasunari, Kanaya Takahiro, Suzuki Shuichi, Lefor Alan Kawarai, Katsukawa Hajime, Kotani Toru
Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, 2-92 Higashiuzura, Gifu 500-8281, Japan.
J Clin Med. 2022 May 5;11(9):2587. doi: 10.3390/jcm11092587.
This is a prospective multicenter cohort study aiming to investigate the association between early mobilization (EM), defined as a rehabilitation level of sitting at the edge of the bed or higher within 72 h of ICU admission, and psychiatric outcome. Consecutive patients, admitted to the ICU for more than 48 h, were enrolled. The primary outcome was the incidence of psychiatric symptoms at 3 months after hospital discharge defined as the presence of any of three symptoms: depression, anxiety, or post-traumatic stress disorder (PTSD). Risk ratio (RR) and multiple logistic regression analysis were used. As a sensitivity analysis, two methods for inverse probability of treatment weighting statistics were performed. Of the 192 discharged patients, 99 (52%) were assessed. The patients who achieved EM had a lower incidence of psychiatric symptoms compared to those who did not (25% vs. 51%, -value 0.008, odds ratio (OR) 0.27, adjusted = 0.032). The RR for psychiatric symptoms in the EM group was 0.49 [95% Confidence Interval, 0.29-0.83]. Sensitivity analysis accounting for the influence of death, loss to follow-up (OR 0.28, adjusted = 0.008), or potential confounders (OR 0.49, adjusted = 0.046) consistently showed a lower incidence of psychiatric symptoms in the EM group. EM was consistently associated with fewer psychiatric symptoms.
这是一项前瞻性多中心队列研究，旨在调查早期活动（EM）与精神科结局之间的关联。早期活动定义为在入住重症监护病房（ICU）72小时内达到坐在床边或更高位置的康复水平。连续入住ICU超过48小时的患者被纳入研究。主要结局是出院后3个月时精神症状的发生率，定义为出现以下三种症状中的任何一种：抑郁、焦虑或创伤后应激障碍（PTSD）。采用风险比（RR）和多因素逻辑回归分析。作为敏感性分析，进行了两种治疗加权统计的逆概率方法。在192名出院患者中，99名（52%）接受了评估。与未实现早期活动的患者相比，实现早期活动的患者精神症状发生率较低（25%对51%，P值0.008，优势比（OR）0.27，校正后P = 0.032）。早期活动组精神症状的RR为0.49[95%置信区间，0.29 - 0.83]。考虑死亡、失访影响（OR 0.28，校正后P = 0.008）或潜在混杂因素（OR 0.49，校正后P = 0.046）的敏感性分析一致显示早期活动组精神症状发生率较低。早期活动与较少的精神症状始终相关。
