中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2015年
9期
545-548
,共4页
李玉萍%谢冬%杨健%陈昶%范江%宋晓%沈蕾%姜格宁
李玉萍%謝鼕%楊健%陳昶%範江%宋曉%瀋蕾%薑格寧
리옥평%사동%양건%진창%범강%송효%침뢰%강격저
重症监护病房%重返%并发症%急性生理学与慢性健康状况评分系统
重癥鑑護病房%重返%併髮癥%急性生理學與慢性健康狀況評分繫統
중증감호병방%중반%병발증%급성생이학여만성건강상황평분계통
Intensive care unit%Patient readmission%Complications%Acute physiology and chronic health evaluation
目的 探讨普胸外科重症监护病房(surgical intensive care unit,SICU)患者重返原因以及影响重返患者预后的危险因素.方法 回顾2011年1月至2013年8月上海市肺科医院胸外科9 022例患者中72例重返SICU患者的临床资料,分析其重返原因并采用多元逐步回归分析重返的危险因素.结果 重返率0.80％ (72/9 022),男55例,女17例;年龄18～ 80岁,平均(59.76±11.87)岁;56.9％(41/72)在转出SICU 48 h内重返.重返者病死率20.8％ (15/72),存活组重返原因以手术相关并发症(66.7％)和呼吸系统并发症(22.8％)为主;死亡组以呼吸系统并发症(66.7％)为主.重返SICU时急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chromic health evaluation,APACHEⅡ)评分＞10分患者的病死率41.2％(14/34)远高于评分较低者的2.6％(1/38),高评分组首次停留天数、重返停留天数和总住院天数均高于低评分组(P＜0.05).经多元逐步回归分析显示,重返SICU时APACHEⅡ评分是影响重返SICU患者预后的独立危险因素.结论 手术相关并发症、肺部感染以及肺动脉栓塞是普胸外科术后重返ICU的最常见因素.肺部感染和肺动脉栓塞是重返后患者死亡的最主要原因.重返时APACHEⅡ评分可用于评估重返者的近期预后.
目的 探討普胸外科重癥鑑護病房(surgical intensive care unit,SICU)患者重返原因以及影響重返患者預後的危險因素.方法 迴顧2011年1月至2013年8月上海市肺科醫院胸外科9 022例患者中72例重返SICU患者的臨床資料,分析其重返原因併採用多元逐步迴歸分析重返的危險因素.結果 重返率0.80％ (72/9 022),男55例,女17例;年齡18～ 80歲,平均(59.76±11.87)歲;56.9％(41/72)在轉齣SICU 48 h內重返.重返者病死率20.8％ (15/72),存活組重返原因以手術相關併髮癥(66.7％)和呼吸繫統併髮癥(22.8％)為主;死亡組以呼吸繫統併髮癥(66.7％)為主.重返SICU時急性生理學與慢性健康狀況評分繫統Ⅱ(acute physiology and chromic health evaluation,APACHEⅡ)評分＞10分患者的病死率41.2％(14/34)遠高于評分較低者的2.6％(1/38),高評分組首次停留天數、重返停留天數和總住院天數均高于低評分組(P＜0.05).經多元逐步迴歸分析顯示,重返SICU時APACHEⅡ評分是影響重返SICU患者預後的獨立危險因素.結論 手術相關併髮癥、肺部感染以及肺動脈栓塞是普胸外科術後重返ICU的最常見因素.肺部感染和肺動脈栓塞是重返後患者死亡的最主要原因.重返時APACHEⅡ評分可用于評估重返者的近期預後.
목적 탐토보흉외과중증감호병방(surgical intensive care unit,SICU)환자중반원인이급영향중반환자예후적위험인소.방법 회고2011년1월지2013년8월상해시폐과의원흉외과9 022례환자중72례중반SICU환자적림상자료,분석기중반원인병채용다원축보회귀분석중반적위험인소.결과 중반솔0.80％ (72/9 022),남55례,녀17례;년령18～ 80세,평균(59.76±11.87)세;56.9％(41/72)재전출SICU 48 h내중반.중반자병사솔20.8％ (15/72),존활조중반원인이수술상관병발증(66.7％)화호흡계통병발증(22.8％)위주;사망조이호흡계통병발증(66.7％)위주.중반SICU시급성생이학여만성건강상황평분계통Ⅱ(acute physiology and chromic health evaluation,APACHEⅡ)평분＞10분환자적병사솔41.2％(14/34)원고우평분교저자적2.6％(1/38),고평분조수차정류천수、중반정류천수화총주원천수균고우저평분조(P＜0.05).경다원축보회귀분석현시,중반SICU시APACHEⅡ평분시영향중반SICU환자예후적독립위험인소.결론 수술상관병발증、폐부감염이급폐동맥전새시보흉외과술후중반ICU적최상견인소.폐부감염화폐동맥전새시중반후환자사망적최주요원인.중반시APACHEⅡ평분가용우평고중반자적근기예후.
Objective To evaluate the causes,risk factors,and mortality rates associated with readmission to thoracic (noncardiac) surgical intensive care unit (SICU).Methods This retrospective cohort study used 9 022 patients after thoracic surgery in the tertiary hospital from January 1,2011 to August 1,2013.72 patients readmitted to the SICU were analyzed and assessed by univariate and multiple step wise regression analysis.Results Of all the 9 022 SICU discharges,72 (0.80％) patients were readmitted.There were 55 males and 17 females with a mean age of 59.8 years(range:18-80).Among them,42 (58.3％)patients were over 60 years old,and a total of 41 patients(56.9％) were readmitted to the SICU within 48 hours.The mortality of readmitted patients was 20.8％ (15/72).The postoperative (66.7％) and respiratory related complications (22.8％) were the most common causes of SICU readmission in survivor group.Respiratory disease (66.7％) was the most common diagnosis for patients readmitted with a new complication in death group.The in-hospital mortality of readmitted patients(APACHE Ⅱ score ＞ 10 points) plagued a staggering 41.2 percent,15 times higher than the low score group.They had more ICU stay days,readmission days and total hospitalization days(P ＜ 0.05).The APACHE Ⅱ scores at time of SICU readmission were found to be the independent risk factors of death as shown by multiple step wise regression analysis.Conclusion SICU readmission prolongs the length of hospital stay and increases the hospital mortality.Monitoring the APACHE Ⅱ score could be useful in evaluating the prognosis.
