重症患者的肌肉强度轨迹和结果:一个前性的多中心队列研究
Ting-Ting Wu1, Xiu-Xia Lin2, Gao-Yan Chen2
1Department of Nursing, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; School of Nursing, Fujian Medical University, Fuzhou, China.
Intensive & critical care nursing
|January 9, 2025
概括
在ICU患者中发现了三种肌肉强度轨迹. 低水平稳定性组,在老年女性患者中常见,呼吸时间长,面临更高的1个月死亡率,突出了早期干预的必要性.
科学领域:
- 关键护理医学 关键护理医学
- 康复科学 康复科学 康复科学
- 老年医学 老年医学
背景情况:
- 肌肉强度的下降是重症监护室 (ICU) 患者的一个重大问题.
- 了解肌肉力量轨迹及其预测因素对于改善患者的治疗结果至关重要.
- 关于肌肉力量对这一群体死亡率的长期影响的数据有限.
研究的目的:
- 在ICU患者中识别不同的肌肉强度轨迹.
- 确定与不同肌肉力量轨迹相关的因素.
- 评估这些轨迹对1个月,6个月和12个月死亡率的影响.
主要方法:
- 未来的多中心队列研究涉及中国10个重症监护室的317名患者.
- 肌肉强度通过ICU入院,ICU出院和医院出院时的手握强度来评估.
- 基于组的轨迹建模和多项物流分析用于轨迹识别和预测分析;Cox比例危险模型用于死亡结果.
主要成果:
- 确定了三个肌肉力量轨迹:低水平稳定 (38.17%),中等水平改善 (47.00%) 和高水平改善 (14.83%).
- 年龄较大 (≥65岁),女性性别,长时间的机械通风和较低的无脂肪质量预测了低水平稳定性轨迹.
- 与低水平稳定性组相比,中等水平改善组显示1个月死亡风险显著降低 (0.067倍).
结论:
- 在ICU幸存者中存在明显的肌肉力量轨迹,对死亡率有重大影响.
- 预测预后不佳的低水平稳定轨迹的预测因素包括年龄较大,女性性别,长时间的通风和减少的无脂肪质量.
- 在低稳定性组中,对高风险患者的早期诊断和量身定制的康复可以改善临床结果并降低死亡率.
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