创伤急救体系相关因素对患者住ICU时间的影响  

Effect of trauma emergency care related factors on length of ICU stay

作　　者：李天琅[1] 李辉[2] 沈伟锋[2] 何小军[3] 伍峻松[2] 易建华[2] 马岳峰[4] 

机构地区：[1]浙江大学医学院附属第二医院干部科,杭州310009 [2]浙江大学医学院附属第二医院急诊中心 [3]《中华急诊医学杂志》编辑部 [4]浙江大学急救医学研究所

出　　处：《中华创伤杂志》2012年第5期432-436,共5页Chinese Journal of Trauma

基　　金：卫生部科学研究基金资助项目（WKJ2007-2-013）

摘　　要：目的探讨创伤急救体系相关因素对患者住ICU时间的影响，并找出导致住ICU时间延长的独立危险因素。方法回顾性分析2009年浙江省5所三级医院急诊室首诊并入住ICU的1361例创伤患者，通过Logistic回归模型筛选出导致患者住ICU时间延长（≥15d）的独立危险因素。结果共有192例住ICU时间≥15d，占14．1％。单因素分析结果提示，ISS≥16分、GCS≤7分、钝性伤、院前急救、急诊室滞留时间≥4h、机械通气和中心静脉压监测与创伤患者住ICU时间延长相关。多因素Logistic回归分析结果提示，院前急救是创伤患者住ICU时间≥15d的保护因素，机械通气、急诊室滞留时间I〉4h、ISS≥16分是创伤患者住ICU时间≥15d的独立危险因素。结论院前急救以及ICU救治对患者住ICU时间有着重要的影响。缩短患者在急诊室的滞留时间有助于减少患者住ICU时间。Objective To investigate the effect of factors correlated with trauma emergency care system on the length of ICU stay and figure out independent risk factors of prolonged ICU stay. Methods A total of 1 361 trauma patients admitted to the ICU of five tertiary hospitals in Zhejiang province in 2009 were retrospectively studied. Demographic data, time of ICU stay and variables related to trauma care were collected. Logistic regression was performed to determine the independent risk factors of prolonged ICU stay （ ≥ 15 days）. Results Overall, 192 trauma patients （ 14.1% ） had a prolonged ICU stay （ ≥15 days）. Single factor analysis indicated that ISS ≥ 16 points, GCS ≤ 7 points, blunt trauma, prehospital emergency care, length of emergency department stay 1〉4 hours, mechanical ventilation and central venous pressure monitoring were associated with the prolonged ICU stay. Multivariate analysis showed that pre-hospital emergency care was a protective factor for the prolonged ICU stay（ ≥ 15 days） and that mechanical ventilation, length of emergency room stay ≥4 hours and ISS ≥ 16 points were the independent risk factors for the prolonged ICU stay （ ≥ 15 days）. Conclusions Pre-hospital emergency care and ICU care show significant influence on the length of ICU stay. Furthermore, shortened length of emergency department stay is also contributive to reduced length of ICU stay.

关 键 词：急救医疗服务 重症监护 危险因素 住ICU时间 

分 类 号：R459.7[医药卫生—急诊医学]