普胸外科重返重症监护室患者术后并发症分析  

Analysis of readmissions to the thoracic surgical intensive care unit

作　　者：李玉萍[1] 谢冬[1] 杨健[1] 陈昶[1] 范江[1] 宋晓[1] 沈蕾[1] 姜格宁[1] 

机构地区：[1]200433同济大学附属上海市肺科医院

出　　处：《中华胸心血管外科杂志》2015年第9期545-548,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：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9022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％（72／9022），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SICU48h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。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.

关 键 词：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 

分 类 号：R193[医药卫生—卫生事业管理]