关键词: 重症肺炎, 谵妄, 感染, 生存率, 生活质量, 疾病不确定感, 满意度, 护理

Abstract:

Objective To investigate the feasibility and safety of family participation in the care of patients with severe pneumonia and its impact on the family of patients. Methods For severe pneumonia and respiratory failure patients admitted to three adult ICUs of a tertiary class A hospital in Gansu Province between March 2019 and March 2023，the patients were divided into an intervention group and a control group based on the preferences of both the patients and their family members. Patients in the control group received routine care. In the intervention group，family members were encouraged to participate in the daily life of patients（washing face，brushing teeth，foot bath，etc.） and participated in the early activities of patients under the guidance of medical personnel. The primary outcomes included the incidence of delirium，cognitive impairment，and 1-year mortality. Results 261 patients were eventually enrolled and assigned to the intervention group（n=134） or control group （n=127）. Incidence of delirium in intervention group and control group were 23.88% and 40.94%，frequency of delirium was （0.61 ± 1.25） vs （1.26 ± 1.82），incidence of cognitive dysfunction 23.88% vs 44.09%，and there were statistically differences（P<0.05）. There was no significant difference in the incidence of ICU acquired weakness，ICU acquired infection and adverse events between groups（P>0.05）. Patients in the intervention group exhibited a higher 1-year survival rate（73.88% vs 59.06%） and quality of life score compared to the control group，and there were statistically differences（P<0.05）. Family members in the intervention group reported lower total illness uncertainty scores than those in the control group（80.11 ± 4.23 vs. 82.91 ± 4.64） and higher overall satisfaction（90.81 ± 5.17 vs. 85.60 ± 4.72），with these differences being statistically significant（P<0.05）. Conclusion The participation of family members in the care of patients with severe pneumonia is not only beneficial to reduce the incidence of delirium and cognitive impairment in patients with severe pneumonia in ICU，shorten the length of hospitalization，improve the quality of life and 1-year survival rate，but also help reduce the uncertainty of disease and improve the satisfaction of family membersn ICU.

Key words: Severe Pneumonia, Delirium, Infection, Survival Rate, Quality of Life, Uncertainty in Illness, Satisfaction, Nursing Care