摘要目的 评估程序化清单查房系统(CERTAIN)在重症加强治疗病房(ICU)中的应用效果.方法采用前瞻性观察性研究方法,选择2018年1月至7月安徽省六安市第二人民医院ICU收治的100例患者(年龄＞18岁、ICU住院时间＞72 h)进行研究.采用便利抽样法,以2018年1月至4月入院的50例患者作为对照组,由3名未告知研究计划的高、中级医师使用普通查房系统查房;2018年3月底,该3名医师通过美国梅奥诊所远程教学培训CERTAIN的使用方法并获得认证,对2018年3月至7月入组的50例患者(作为观察组)使用CERTAIN清单进行查房.CERTAIN清单包含了20个条目,涉及每日危重患者查房所需要涵盖的范围,临床医生需要对每个条目进行量化.收集资料,对比分析两组患者ICU 住院时间、中心静脉导管(CVC)留置时间、尿管留置时间、机械通气时间、药物使用率、ICU 病死率、不良事件发生率等.采用log-rank单因素比较和Cox回归多因素分析影响患者ICU死亡的独立因素.结果 与对照组比较,观察组患者ICU住院时间显著缩短(d :8.68±4.84比13.64±9.37),尿管留置时间(d :8.16±5.29比13.32±9.31)和机械通气时间(d :3.46±4.14比6.62±9.57)也明显缩短,胰岛素使用率(34.0%比56.0%)、ICU病死率(2.0%比14.0%)明显下降(均P＜0.05).此外,CERTAIN清单的使用可使医师的查房效率显著提高,查房时间由普通查房系统的(8.00±0.45)min缩短到(5.00±0.33)min(t＝9.312,P＜0.01).Log-rank单因素比较显示,CERTAIN清单的应用可以降低ICU病死率(χ2＝3.898,P＝0.048),但是多元Cox回归分析显示,CERTAIN清单的应用并不是降低ICU病死率的一个独立因素〔优势比(OR)＝1.001,P＝0.922〕.结论 CERTAIN清单应用在ICU患者中效果显著,可在我国重症医学科室进一步推广.

abstractsObjective To evaluate the clinical performance of checklist for early recognition and treatment of acute illness (CERTAIN) on patients in the intensive care unit (ICU). Methods A prospective observational study was performed. 100 patients (age > 18 years old, the length of ICU stay > 72 hours) admitted to ICU of the Second People's Hospital of Lu'an from January to July in 2018 were enrolled. By convenience sampling methods, 50 patients admitted to the hospital from January to April in 2018 were selected as the control group. Standard ward inspection was given to the control group by three senior-level and intermediate-level doctors blinded from the research plan; at the end of March 2018, these three doctors were trained with the CERTAIN checklist and certified by the Mayo Clinic distance learning training. Fifty patients enrolled from March to July 2018 received medical rounds using CERTAIN (observation group). The CERTAIN checklist contained 20 items that cover the range of daily critical ward rounds, which need clinicians to quantify each item. The data included the length of ICU stay, central venous catheter (CVC) indwelling time, catheter indwelling time, duration of mechanical ventilation, drug use rate, ICU mortality, and incidence of adverse events were collected and compared between the two groups. The independent factors affecting ICU death were analyzed by log-rank univariate analysis and Cox regression multivariate analysis. Results Compared with control group, the length of ICU stay (days: 8.68±4.84 vs. 13.64±9.37), catheter indwelling time (days: 8.16±5.29 vs. 13.32±9.31), duration of mechanical ventilation (days: 3.46±4.14 vs. 6.62±9.57) in observation group were significantly decreased, insulin use rate (34.0% vs. 56.0%) and ICU mortality (2.0% vs. 14.0%) were significantly decreased, with statistically significant differences (all P < 0.05). Besides, the use of CERTAIN can significantly improve the efficiency of the ward inspection. The ward inspection time was shortened from (8.00±0.45) minutes to (5.00±0.33) minutes by using the CERTAIN checklist (t = 9.312, P < 0.01). Survival analysis showed that CERTAIN application could reduce ICU mortality (χ2= 3.898, P = 0.048), but the use of CERTAIN was not an independent factor for reducing ICU mortality [odds ratios (OR) = 1.001, P = 0.922]. Conclusions CERTAIN application has a significant effect on critical patients. It is suggested to spread in ICU of China.