成人心脏术后再入ICU的危险因素分析  被引量:5

Predictors analysis of ICU readmission after cardiac surgery

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作  者:陈成[1] 葛敏[1] 陈涛[1] 陆利冲[1] 王东进[1] 

机构地区:[1]南京大学医学院附属鼓楼医院心胸外科,南京210008

出  处:《中国胸心血管外科临床杂志》2017年第7期522-526,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基  金:江苏省省级条件建设与民生科技专项资金(BL2014004)

摘  要:目的评估心脏术后再次转入ICU的危险因素。方法纳入2014年1月至2016年10月共2 799例心脏手术患者,分为再入ICU组[47例,男27例、女20例,年龄(62.0±14.4)岁]及非再入ICU组[2 752例,男1 478例、女1 274例,年龄(55.0±13.9)岁]。分析再入ICU的原因,并通过logistic回归分析明确再次转入ICU的围术期危险因素。结果再入ICU的发生率为1.68%(47/2 799),呼吸衰竭是再入ICU的最主要的原因(38.3%),再入ICU组的死亡率较非再入ICU组高,且差异有统计学意义(23.4%vs.4.6%,P<0.001)。Logistic回归分析得出术前肾功能不全(OR=5.243,95%CI 1.190~23.093,P=0.029)、ICU停留时间(OR=1.002,95%CI1.001~1.004,P=0.049)、术后第1 d B型尿钠肽(BNP)值(OR=1.000,95%CI 1.000~1.001,P=0.038)、入室24 h急性生理与慢性健康(APACHEⅡ)评分(OR=1.171,95%CI 1.088~1.259,P<0.001)、术后当天引流量(OR=1.001,95%CI1.001~1.002,P<0.001)为心脏术后再次转入ICU的独立危险因素。结论早期识别心脏术后再次转入ICU的独立危险因素,有助于更有效地制定高危患者的治疗计划及分配医疗资源。Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P〈O.OO1). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=I.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluation II (APACHE II ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 tol.259, P〈O.O01), and the drainage on the day of surgery (OR= 1.001, 95%CI1.001 to 1.002, P〈0.001 ) were the independent risk factors for readmission to the cardiac surgery ICU. Condusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient heahhcare planning and resources allocation.

关 键 词:心脏手术 再次转入 重症监护室 

分 类 号:R654.2[医药卫生—外科学]

 

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