中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
Chinese Journal of Multiple Organ Diseases in the Elderly
2015年
10期
763-766
,共4页
杨健%郭振辉%董家辉%孙杰%陈蕊%肖飞%熊日成%刘坚%杨明常%俞宙
楊健%郭振輝%董傢輝%孫傑%陳蕊%肖飛%熊日成%劉堅%楊明常%俞宙
양건%곽진휘%동가휘%손걸%진예%초비%웅일성%류견%양명상%유주
老年人%重症患者%专科救治技术
老年人%重癥患者%專科救治技術
노년인%중증환자%전과구치기술
elderly%critically ill patients%professional rescue technique
目的：探讨老年重症患者诊疗过程中专业化救治技术的运用与实践。方法以高龄老年重症患者为研究群体，收集广州军区广州总医院老年重症医学科自2007年6月至2014年6月期间收治的病情危重症患者病例；动态观察重症患者收容量、病情严重程度、技术应用情况、抢救成功率、年度总死亡人数、平均住院天数与医疗费用等随时间的变化。结果进行专业化诊治的老年重症患者由295例增到347例（P＜0.001）；年龄由（80.3±6.9）岁增至（87.4±7.6）岁（P＜0.001）；APACHEⅡ评分由（13.6±3.9）分增至（20.6±3.9）分（P＜0.001）。其中，APACHEⅡ评分≥15分的患者所占百分比由25.2%增至40.6%（P＜0.05）。纤维支气管镜检查、机械通气和血液滤过等专科技术的年平均使用率均大幅降低。抢救成功率由52.2%提高到了72.3%；患者平均住院天数由42.5d缩短至16.3d；医疗费用降低＞25%（均P＜0.05）。结论在患者年龄、收容量与病情严重程度逐年增大的情况下，通过专业救治，我院的老年重症患者器官功能支持技术总体使用率显著降低，抢救成功率显著增加，同时患者入住ICU的时间和医疗费用大幅减少。表明老年重症医学科的专科技术应用对老年患者的治疗与预后具有很大的帮助。
目的：探討老年重癥患者診療過程中專業化救治技術的運用與實踐。方法以高齡老年重癥患者為研究群體，收集廣州軍區廣州總醫院老年重癥醫學科自2007年6月至2014年6月期間收治的病情危重癥患者病例；動態觀察重癥患者收容量、病情嚴重程度、技術應用情況、搶救成功率、年度總死亡人數、平均住院天數與醫療費用等隨時間的變化。結果進行專業化診治的老年重癥患者由295例增到347例（P＜0.001）；年齡由（80.3±6.9）歲增至（87.4±7.6）歲（P＜0.001）；APACHEⅡ評分由（13.6±3.9）分增至（20.6±3.9）分（P＜0.001）。其中，APACHEⅡ評分≥15分的患者所佔百分比由25.2%增至40.6%（P＜0.05）。纖維支氣管鏡檢查、機械通氣和血液濾過等專科技術的年平均使用率均大幅降低。搶救成功率由52.2%提高到瞭72.3%；患者平均住院天數由42.5d縮短至16.3d；醫療費用降低＞25%（均P＜0.05）。結論在患者年齡、收容量與病情嚴重程度逐年增大的情況下，通過專業救治，我院的老年重癥患者器官功能支持技術總體使用率顯著降低，搶救成功率顯著增加，同時患者入住ICU的時間和醫療費用大幅減少。錶明老年重癥醫學科的專科技術應用對老年患者的治療與預後具有很大的幫助。
목적：탐토노년중증환자진료과정중전업화구치기술적운용여실천。방법이고령노년중증환자위연구군체，수집엄주군구엄주총의원노년중증의학과자2007년6월지2014년6월기간수치적병정위중증환자병례；동태관찰중증환자수용량、병정엄중정도、기술응용정황、창구성공솔、년도총사망인수、평균주원천수여의료비용등수시간적변화。결과진행전업화진치적노년중증환자유295례증도347례（P＜0.001）；년령유（80.3±6.9）세증지（87.4±7.6）세（P＜0.001）；APACHEⅡ평분유（13.6±3.9）분증지（20.6±3.9）분（P＜0.001）。기중，APACHEⅡ평분≥15분적환자소점백분비유25.2%증지40.6%（P＜0.05）。섬유지기관경검사、궤계통기화혈액려과등전과기술적년평균사용솔균대폭강저。창구성공솔유52.2%제고도료72.3%；환자평균주원천수유42.5d축단지16.3d；의료비용강저＞25%（균P＜0.05）。결론재환자년령、수용량여병정엄중정도축년증대적정황하，통과전업구치，아원적노년중증환자기관공능지지기술총체사용솔현저강저，창구성공솔현저증가，동시환자입주ICU적시간화의료비용대폭감소。표명노년중증의학과적전과기술응용대노년환자적치료여예후구유흔대적방조。
Objective To investigate the application of professional rescue techniques in the diagnosis and treatment of critically ill elderly. Methods A retrospective analysis was performed on the critically ill elderly patients from Department of Geriatric Critical Care Medicine from June 2007 to June 2014. Total number of residents in geriatric critical care medicine, severity of illness, application of rescue techniques, success rate, annual mortality, average length of hospital stay and medical expenses were observed and analyzed. Results The total number of residents rose from 295 in the year of 2007 to 347 in the year of 2014. Their age was increased from (80.3±6.9) years to (87.4±7.6) years (P<0.001), and APACHEⅡ was elevated from (13.6±3.9) to (20.6±3.9) (P<0.001). What’ more, the percentage of patients with APACHEⅡ score over 15 were increased from 25.2% to 40.6% (P<0.05). During 2007 to 2014, the employment of professional rescue techniques as fiberbronchoscopy, mechanical ventilation and continuous veno-venous hemofiltration were dramatically decreased, while the success rate of rescue was remarkably elevated from 52.2% to 72.3%. The average length of hospital stay was also shortened from 42.5d to 16.3d, and thus the medical expenses were declined by more than 25%. Conclusion Though the age, amount and severity of the critically ill elderly are increased, specialized professional treatment greatly decreases the employment of professional rescue techniques, increases the success rate, and significantly reduces the ICU stay time and medical expenses. All these indicate that professional rescue techniques are of great helpfulness for the diagnosis, treatment and prognosis of the elderly in geriatric critical care medicine.
