重症监护室慢性危重症危险因素分析  

Risk factors for developing chronic critical illness among critically ill patients in intensive care unit

作　　者：陈兰春[1] 刘慧醒 李展汉 佘晓龙 余雪涛[1] CHEN Lan-chun;LIU Hui-xing;LI Zhan-han;SHE Xiao-long;YU Xue-tao(ICU Department of Longgang District People's Hospital of Shenzhen,Shenzhen,Guangdong 518172)

机构地区：[1]深圳市龙岗区人民医院重症医学科,广东深圳518172

出　　处：《赣南医学院学报》2021年第12期1233-1237,1267,共6页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：深圳市龙岗区科技创新局立项项目(LGKCYLWS2020053)。

摘　　要：目的:探讨重症监护室(Intensive Care Unit,ICU)慢性危重症疾病(Chronic critical illness,CCI)发生的危险因素,为其早期防治提供临床依据。方法:回顾性分析2014年1月至2018年12月在本院ICU住院的危重症患者,将符合要求的患者按照CCI的诊断标准分为CCI组和非CCI组,收集两组的临床资料,包括性别、年龄、入ICU时的急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官功能衰竭评分(SOFA)、入ICU的诊断、血常规、住ICU时间、临床转归以及是否接受机械通气和血液净化治疗等。比较两组各项指标,将差异有统计学意义的指标纳入多因素Logistic回归分析。结果:ICU收治患者共1 196例,861例符合纳入要求,CCI组98例,非CCI组763例;与非CCI组比较,CCI组入ICU时APACHEⅡ评分更高,基础疾病数目更多,接受机械通气和血液净化支持治疗的比例更高,差异有统计学意义(P均<0.05);入ICU后第1天两组的WBC、Plt和Lym计数以及Hb水平差异均无统计学意义(P均>0.05),入ICU后第7天,CCI组的WBC、Nue高于非CCI组,Hb、Plt及Lym低于非CCI组(P均<0.05);多因素Logistics回归分析显示APACHEⅡ评分、基础疾病数目、感染、入ICU后第7天Plt和Lym减少是发生CCI的独立危险因素(P均<0.05)。结论:ICU的危重患者,尤其是脓毒症、基础疾病多和(或)入科APACHEⅡ评分高以及入ICU后第7天Plt和Lym低下的,应高度警惕其发展为CCI,早期采取恰当的干预措施,改善疾病预后。Objective:To investigate the risk factors of development of the critically ill patients of CCI for further management of CCI.Methods:A retrospective study of patients who admitted to ICU from January 2014 to December 2018 was conducted. Patients meeting the inclusion criteria were enrolled and divided into two groups(CCI group and non-CCI group)according to CCI diagnosis criteria. Patient characteristics and clinical data were collected and analyzed,Ingcluding gender,age,evaluation Ⅱ(APACHE Ⅱ)of acute physiology and chronic health score at admission to ICU,sequential organ failure assessment(SOFA),Diagnosis at admission to ICU,routine blood test,length of stay in ICU,clinical outcome and whether to receive mechanical ventilation and blood purification treatment. The indexes with significant difference between the two groups were analyzed statistically by multivariate logistic regression analysis.Results:A total of 1 196 cases were studied of which 861 patients meeting inclusion criteria were ultimately enrolled in analysis,including98 patients(11. 4%)in CCI group and 763(88. 6%)in non-CCI group. Patients who developed CCI had higher APACHⅡ score on ICU admission,more comorbidities and higher requirement of MV and CRRT compared with patients in non-CCI group,with statistical significance(P<0. 05). there was no significant difference in WBC,Plt,Lym counts and Hb levels between the two groups on ICU admission(P>0. 05). WBC and Nue in CCI group were higher than those in non-CCI group,and Hb,Plt and Lym were lower than those in non-CCI group(P<0. 05). Multivariate Logistic regression analysis showed that the level of APACHE Ⅱ score,the number of comorbidities,sepsis,and decreased Plt and Lym counts on ICU day seven were the independent risk factors for the development of CCI(P<0. 05).Conclusion:Patients with High APACH Ⅱ score on ICU admission,especially the situation of severe sepsis,many comorbidities and decreased Plt and Lym count on ICU day seven inclining to develop CCI should be seriously concerned. A

关 键 词：重症监护室 危重 慢性危重症 危险因素 

分 类 号：R442.8[医药卫生—诊断学]