Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
J Intensive Care Med. 2024 Mar;39(3):257-267. doi: 10.1177/08850666231200184. Epub 2023 Sep 18.
To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. In accordance with the study criteria, 1019 patients were finally enrolled. Compared with patients in the control group, those in the treatment group had significantly fewer days on mechanical ventilation [5 (4, 7) versus 5 (4, 7) days, = .03] and lower intensive care unit (ICU) mortality [21.1% (132 of 627) vs 28.8% (113 of 392); = .005] and 28-day mortality [22.2% (139 of 627) vs 29.8% (117 of 392); = .006]. The treatment group also had a shorter duration of ICU stay [9 (5, 15) vs 11 (6, 22) days, = .0001] than the control group. The improved nursing strategy acted as an independent protective factor in 28-day mortality: odds ratio 0.645, 95% confidence interval: 0.449-0.927, = .018. Our improved nursing strategy shortened the duration of mechanical ventilation and the ICU stay and decreased ICU mortality and 28-day mortality in immunosuppressed patients with pneumonia and sepsis. ChiCTR.org.cn, ChiCTR-ROC-17010750. Registered 28 February 2017.
探讨改良护理策略对免疫抑制肺炎合并脓毒症患者预后的影响。
纳入免疫抑制（绝对淋巴细胞计数<1000 个/ mm）肺炎合并脓毒症患者，分为对照组和治疗组。治疗组采用改良护理策略。本研究的主要结局为 28 天死亡率。根据研究标准，最终纳入 1019 例患者。与对照组相比，治疗组机械通气时间明显缩短[5（4，7）天比 5（4，7）天，=0.03]，重症监护病房（ICU）死亡率[21.1%（132/627）比 28.8%（113/392），=0.005]和 28 天死亡率[22.2%（139/627）比 29.8%（117/392），=0.006]均降低。治疗组 ICU 住院时间也明显短于对照组[9（5，15）天比 11（6，22）天，=0.0001]。改良护理策略是 28 天死亡率的独立保护因素：比值比 0.645，95%置信区间：0.449-0.927，=0.018。
改良护理策略可缩短免疫抑制肺炎合并脓毒症患者机械通气时间和 ICU 住院时间，降低 ICU 死亡率和 28 天死亡率。
ChiCTR.org.cn，ChiCTR-ROC-17010750。注册日期：2017 年 2 月 28 日。
