关键词: 重症监护病房, ICU后综合征, 潜在类别分析, 影响因素, 护理

Abstract:

Objective To explore the latent classes of symptom characteristics of post-intensive care syndrome（PICS）patients and to analyze the differences in demographic and disease characteristics of patients among different classes. Methods According to the inclusion and exclusion criteria,patients in the general ICU of a tertiary hospital in Guizhou were selected as the research subjects from August 16,2019 to January 16,2020,and from June 8,2020 to October 30,2020 by using convenient sampling method. Patients were followed up by telephone after being transferred out of ICU for 1 month to assess their PICS-related symptoms. Latent class analysis（LCA）was used to explore the latent classes of the symptom characteristics of PICS patients. Single factor analysis and multiple logistic regression were used to identify the influencing factors of the latent classes of PICS. Results A total of 299 samples were obtained and PICS occurred in 165 patients（55.18%）. The symptom characteristics of PICS could be divided into 3 latent classes,which were named as “fatigue-sleep disorder group”（44.24%）,“anxiety group”（16.97%）,and “high symptom group”（38.79%）. Compared “high symptom group” with “fatigue-sleep disorder group”,the higher acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score was,the less likely it was to be classified as “fatigue-sleep disorder group”（OR=0.882,P=0.001）,and the more likely it was to be classified as “fatigue-sleep disorder group” without respiratory disease history or tracheotomy（OR=5.443,P=0.048;OR=4.015,P=0.006）. Compared “high symptom group” with “anxiety group”,the higher APACHE Ⅱ score was Less likely to be classified to be “anxiety group”（OR=0.903,P=0.027）,and patients younger than 50 years old were more likely to be classified as “anxiety group”（OR=3.392,P=0.025）. Compared with “fatigue-sleep disorder group”,patients with age younger than 50 years were more likely to be classified as “anxiety group”（OR=4.422,P=0.005）. Conclusion The symptomatic characteristics of PICS are heterogeneous and can be divided into 3 latent classes. Patients with a high APACHE II score,a history of respiratory disease,and a tracheotomy were more likely to be classified as “high symptom group”,while those younger than 50 were more likely to be classified as “anxiety group”. It is suggested that the clinical staff should pay attention to the heterogeneity of PICS individual symptom characteristics and give targeted intervention measures to different classes of patients.

Key words: Intensive Care Unit, Post-Intensive Care Syndrome, Latent Class Analysis, Influencing Factors, Nursing Care