中国慢性危重症及外科相关慢性危重症的多中心横断面研究  

A multicenter cross sectional study on chronic critical illness and surgery related chronic critical illness in China

作　　者：李思澄 吴婕[2] 于湘友[3] 罗苏明[4] 王建忠[5] 罗亮[6] 郑喜胜[7] 韩小宁[8] 李光义[9] 陈英杰 王春亭 黄伶[12] 曾庆军 吴秀文 任建安 Li Sicheng;Wu Jie;Yu Xiangyou;Luo Suming;Wang Jianzhong;Luo Liang;Zheng Xisheng;Han Xiaoning;Li Guangyi;Chen Yingjie;Wang Chunting;Huang Ling;Zeng Qingjun;Wu Xiuwen;Ren Jian′an(Research Institute of General Surgery,East War Zone Hospital of PLA,Nanjing 210002,China;Department of General Surgery,The Affiliated BenQ Hospital,Nanjing Medical University,Nanjing 210019,China;Department of Critical Care Medicine,The First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China;Department of Emergency Trauma Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Department of Gastrointestinal Surgery,The First Affiliated Hospital,Gannan Medical College,Jiangxi Ganzhou 341000,China;Department of Critical Care Medicine,Wuxi Second People′s Hospital,Jiangsu Wuxi 214002,China;Department of General Surgery,Nanyang Central Hospital,Henan Nanyang 473000,China;Department of Critical Care Medicine,Affiliated Hospital,Qingdao University,Shandong Qingdao 266555,China;Department of General Surgery,Hunan Provincial People′s Hospital,Changsha 410000,China;Department of Critical Care Medicine,Jinjiang Hospital of Traditional Chinese Medicine,Fujian Quanzhou 362200,China;Department of Critical Care Medicine,Shandong Provincial Hospital Affiliated of Shandong First Medical University,Jinan 250021,China;Department of Critical Care Medicine,Yantai Mountain Hospital,Shandong Yantai 264000,China;Department of Gastrointestinal Surgery,The First People′s Hospital of Yueyang City,Hunan Yueyang 414000,China)

机构地区：[1]东部战区总医院普通外科研究所,南京210002 [2]南京医科大学附属明基医院普通外科,南京210019 [3]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054 [4]新疆维吾尔自治区人民医院急诊创伤外科,乌鲁木齐830001 [5]赣南医学院第一附属医院胃肠外科,江西赣州341000 [6]无锡市第二人民医院重症医学科,江苏无锡214002 [7]南阳市中心医院重症医学科,河南南阳473000 [8]青岛大学附属医院西海岸院区重症医学科,山东青岛266555 [9]湖南省人民医院普通外科,长沙410000 [10]晋江市中医院重症医学科,福建泉州362200 [11]山东第一医科大学附属省立医院重症医学科,济南250021 [12]烟台市烟台山医院重症医学科,山东烟台264000 [13]岳阳市一人民医院胃肠外科,湖南岳阳414000

出　　处：《中华胃肠外科杂志》2019年第11期1027-1033,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81772052);解放军军事医学创新工程(16CXZ007);江苏省重点研发社会发展项目(BE2016752);江苏省医学重点人才项目(JCRCB2016006);江苏省研究生科研与实践创新计划项目(JX22013565)。

摘　　要：目的了解中国慢性危重症(CCI)、尤其是外科相关CCI的患病率、临床病例特征和诊疗现状。方法采用多中心横断面研究的方法,收集53家医院2019年5月10日当天所有重症监护病房(ICU)住院的472例成年患者临床资料,包括患者基本信息、疾病相关资料、营养方案等。根据是否需要外科手段介入或疾病发生与外科手术直接相关的标准,进一步筛选出外科疾病相关ICU患者211例。本研究中CCI诊断标准为:(1)入住ICU时间>14 d;(2)合并有持续性脏器功能紊乱。记录分析53家单位外科相关ICU患者中CCI患病率、CCI患病分布情况、外科相关CCI患者疾病分布情况和治疗情况。采用Mann Whitney U检验、χ2检验或Fisher精确概率法检验进行比较分析。结果53家医院的472例ICU患者中,男性326例(69.1%),女性146例(30.9%),外科相关CCI的患病率为30.7%(145/472)。在211例外科疾病相关ICU患者中,CCI患者57例,患病率27.0%。与非CCI患者相比,外科相关CCI患者具有较高的急性生理改变及慢性健康评估系统评分(APACHEⅡ)[13.5(10.0,18.3)分比11.0(7.0,16.0)分,U=2970.000,P=0.007]、较高的查尔森合并症指数[4.0(2.0,7.0)分比3.0(1.0,5.0)分,U=3570.000,P=0.036]以及较高比例的呼吸、肾功能障碍[68.4%(39/57)比48.1%(74/154),χ2=6.939,P=0.008;42.1%(24/57)比18.2%(28/154),χ2=12.821,P<0.001];而两组序贯性脏器衰竭评分(SOFA)、格拉斯哥昏迷评分及其余系统脏器功能差异均无统计学意义(均P>0.05)。通过重症患者营养风险评分(NUTRIC)评估发现,外科相关CCI患者营养风险高于非CCI者[43.9%(25/57)比26.6%(41/154),U=5.750,P=0.016]。外科相关CCI患者使用机械通气比例更高[66.7%(38/57)比52.3%(79/154),χ2=3.977,P=0.046]。调查当日,50.2%(106/211)外科相关ICU患者的每日热量需求是依据成人标准热量摄入指标[(104.6~125.5)kJ·kg 1·d 1;1 kJ=0.239 kcal]得出,46.4%(98/211)患者由医师根据患者病情程度计算得出每日热量需�Objective To understand the prevalence,diagnosis and treatment of chronic critical illness(CCI)in China.Methods The clinical data of 472 adult patients admitted to ICU in 53 hospitals,including basic information,disease related data,nutrition program,etc.,were collected on May 10,2019,by means of multi center cross sectional study.If surgical intervention was needed or the occurrence of the disease was directly related to the surgery,ICU patients were regarded as surgical ICU cases(n=211).In this study,the diagnostic criteria for CCI were:(1)admission to ICU>14 days;(2)combined with persistent organ dysfunction.The prevalence,distribution and treatment of CCI and surgery related CCI were recorded and analyzed.The Mann Whitney U test,chi square test or Fisher exact test were used for comparative analysis.Results Among the 472 ICU patients from 53 hospitals,326 were male(69.1%)and 146 were female(30.9%).The prevalence of CCI was 30.7%(145/472).Among 211 surgery related ICU patients,57 developed CCI with a prevalence of 27.0%.As compared to non CCI patients,higher APACHE II score[median(IQR)13.5(10.0,18.3)vs.11.0(7.0,16.0),U=2970.000,P=0.007],higher Charlson comorbidity index[median(IQR)4.0(2.0,7.0)vs.3.0(1.0,5.0),U=3570.000,P=0.036]and higher ratio of breath dysfunction[68.4%(39/57)vs.48.1%(74/154),χ2=6.939,P=0.008]and renal dysfunction[42.1%(24/57)vs.18.2%(28/154),χ2=12.821,P<0.001]were found in surgery related CCI patients.While SOFA score,Glasgow coma score and other visceral function were not significantly different between surgery related CCI and non CCI patients(all P>0.05).NUTRIC score showed that surgery related CCI patients had higher nutritional risk[43.9%(25/57)vs.26.6%(41/154),U=5.750,P=0.016]and higher ratio of mechanical ventilation[66.7%(38/57)vs.52.3%(79/154),χ2=3.977,P=0.046]than non CCI patients.On the survey day,the daily caloric requirements of 50.2%(106/211)of surgery related ICU patients were calculated according to the standard adult caloric intake index(104.6 to 125.5 kJ·kg 1·d 1,1 kJ=0

关 键 词：慢性危重症 横断面研究 患病率 营养支持 

分 类 号：R[医药卫生]