目的:探讨将老年重症监护病房(GICU)纳入老年危重病人友好管理模式的可行性和安全性。
方法:进行前瞻性对照研究。纳入2021年12月至2023年5月在常州市金坛第一人民医院GICU和普通重症监护病房(ICU)就诊的老年危重患者。ICU组患者接受传统的重症监护护理模式。除ICU组基本医疗护理措施外,GICU组患者采用灵活访视等友好管理模式,优化诊断和治疗环境,关怀诊断和治疗,根据病情评估,家庭参与临终关怀。性别,年龄,主要诊断,记录并比较两组患者入院时的急性生理学和慢性健康评估II(APACHEII)。在治疗期间,医院感染的发生率,计划外拔管,从床上掉下来/掉下来,意外再入院ICU/GICU,和ICU/GICU死亡率,重症监护后综合征(PICS)的发病率,患者/家属对医疗护理的满意率,记录并比较两组患者/家属对诊疗环境的满意率。
结果:根据ICU和GICU的入院标准,以及患者和/或其家人的意愿,最终将59例患者纳入ICU组,48例患者纳入GICU组。性别差异不显著,年龄,两组主要诊断及APACHEⅡ评分,并且有可比性。医院感染等不良事件的发生率没有显着差异[13.6%(8/59)与12.5%(6/48)],非计划拔管[5.1%(3/59)vs.6.2%(3/48)],从床上掉下来/跌倒[3.4%(2/59)vs.0%(0/48)],意外再入院ICU/GICU[8.5%(5/59)vs.10.4%(5/48)],和ICU/GICU死亡率[6.8%(4/59)vs.6.2(3/48)]ICU组与GICU组之间(均P>0.05)。与ICU组相比,GICU组的PICS发生率显著降低[8.3%(4/48)vs.25.4%(15/59),P<0.05],患者/家属对医疗护理的满意率[89.6%(43/48)vs.74.6%(44/59)]和患者/家属对诊疗环境的满意率[87.5%(42/48)vs.67.8%(40/59)]显著增高(均P<0.05)。
结论:使用GICU作为老年危重病人的友好管理模式是可行和安全的,值得进一步探索和研究。
OBJECTIVE: To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.
METHODS: A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People\'s Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.
RESULTS: According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05).
CONCLUSIONS: The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.