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重症监护病房患者机械通气撤机结局的心理社会预测因素

Psychosocial Predictors of Ventilator weaning Outcomes among patients in intensive care units.

作者信息

Elsehrawy Mohamed Gamal, Saleh Ahmad M

机构信息

Department of Nursing Administration and Education, Prince Sattam Bin Abdulaziz University, College of Nursing, Kingdom of Saudi Arabia.

Nursing Administration, Nursing Faculty, Port-Said University, Egypt.

出版信息

Heliyon. 2024 Jan 19;10(3):e24385. doi: 10.1016/j.heliyon.2024.e24385. eCollection 2024 Feb 15.

Abstract

BACKGROUND

Ventilator weaning is a process of discontinuing mechanical ventilation and transitioning patients to independent breathing after a period of mechanical support. Weaning outcomes among the critically ill in intensive care units (ICUs) vary significantly among individuals, leading to considerable variation in healthcare costs, length of hospital stay, morbidity and mortality. Addressing psychosocial aspects of care can improve weaning outcomes.

OBJECTIVE

This study aimed to determine the effect of psychosocial factors (social support, family/significant other support, ability to communicate) on weaning outcome within intensive care patients. This research hypothesized that psychological and social factors play a role in determining ventilator weaning outcomes among ICU patients.

METHODS

This study used a longitudinal, retrospective research design to analyze positive and negative psychosocial predictors of ventilator weaning outcomes. Data collection methods include interviews and questionnaires with patients and their families, as well as clinical data from the patient's medical records.

RESULTS

presence of anxiety, depression, and hallucinations, have a negative relationship with weaning outcomes regarding a patient's psychological characteristics (r = -0.207, -0.163, -0.158), while communication with a patient during mechanical ventilation have a positive relationship with weaning outcomes regarding a patient's psychological characteristics (r = 0.152; p ≤ 0.05). Moreover patients who have fear during weaning trials, feeling neglected, and feeling insecurity have a negative relationship with weaning outcomes while gaining family support during mechanical ventilation have a positive relationship with weaning outcomes (rs = 0.144; p ≤ 0.05).Significance of results, the findings suggests that psychosocial factors, such as anxiety, depression, patient's perception of their illness, motivation to wean, and family involvement can influence the success of ventilator weaning among patients in ICUs.

摘要

背景

呼吸机撤机是一个在经过一段时间的机械通气支持后,停止机械通气并使患者过渡到自主呼吸的过程。重症监护病房(ICU)中危重症患者的撤机结果个体差异很大,导致医疗成本、住院时间、发病率和死亡率存在显著差异。关注护理的心理社会方面可以改善撤机结果。

目的

本研究旨在确定心理社会因素(社会支持、家庭/重要他人支持、沟通能力)对ICU患者撤机结果的影响。本研究假设心理和社会因素在决定ICU患者呼吸机撤机结果中起作用。

方法

本研究采用纵向回顾性研究设计,分析呼吸机撤机结果的积极和消极心理社会预测因素。数据收集方法包括对患者及其家属的访谈和问卷调查,以及患者病历中的临床数据。

结果

就患者的心理特征而言,焦虑、抑郁和幻觉的存在与撤机结果呈负相关(r = -0.207、-0.163、-0.158),而在机械通气期间与患者的沟通与撤机结果呈正相关(r = 0.152;p≤0.05)。此外,在撤机试验期间感到恐惧、被忽视和缺乏安全感的患者与撤机结果呈负相关,而在机械通气期间获得家庭支持与撤机结果呈正相关(rs = 0.144;p≤0.05)。结果的意义,研究结果表明,心理社会因素,如焦虑、抑郁、患者对自身疾病的认知、撤机动机和家庭参与度,会影响ICU患者呼吸机撤机的成功率。

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