老年腹部择期术后入住ICU患者死亡危险因素分析——一项连续5年的回顾性研究  

Risk factors for death in elderly patients admitted to intensive care unit after elective abdominal surgery:a consecutive 5-year retrospective study

作　　者：李书文 何天慧 沈锋 王迪芬 刘旭 秦进成 肖川 李伟 李清 高代秀 Li Shuwen;He Tianhui;Shen Feng;Wang Difen;Liu Xu;Qin Jingcheng;Xiao Chuan;Li Wei;Li Qing;Gao Daixiu(Department of Critical Care Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院重症医学科,贵阳550004

出　　处：《中华危重病急救医学》2021年第12期1453-1458,共6页Chinese Critical Care Medicine

基　　金：贵州省卫生健康委科技项目(gzwkj2021-034);国家重点研发计划(2018YFC2001900)。

摘　　要：目的分析导致老年腹部择期术后入住重症监护病房(ICU)患者死亡的危险因素,寻找可靠、敏感的预后预测指标,以期对该类患者实施早干预,进而降低病死率。方法采用回顾性病例对照研究方法,收集2016年1月1日至2020年12月31日贵州医科大学附属医院综合ICU收治的老年(年龄≥65岁)腹部择期术后患者的临床资料,包括患者的性别、年龄、体质量指数(BMI)和既往史、美国麻醉医师学会(ASA)分级、手术分级、术中失血量、手术时间、手术结束至转入ICU间隔时间,以及入住ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和实验室指标最差值、入住ICU首次血气分析、有创机械通气时间、ICU住院时间,根据腹腔引流液病原学培养结果及临床症状体征等因素综合判断是否发生术后腹腔感染。按临床结局将患者分为死亡组和存活组,比较两组临床资料的差异;采用二分类多因素Logistic回归分析筛选出影响老年腹部择期术后入住ICU患者死亡的危险因素,绘制受试者工作特征曲线(ROC曲线),评估各危险因素对患者预后的预测价值。结果5年间本院ICU共收治226例老年腹部择期术后患者,排除入住ICU 24 h内未进行实验室检查者2例,最终224例患者纳入分析,其中存活158例,死亡66例。单因素分析结果显示,与存活组比较,死亡组APACHEⅡ评分、血乳酸(Lac)、术后腹腔感染比例均升高〔APACHEⅡ评分(分):27.5(25.0,31.3)比23.0(18.0,27.0),Lac(mmol/L):2.9(1.8,6.6)比1.8(1.1,2.8),术后腹腔感染比例:65.2%(43/66)比35.4%(56/158),均P<0.01〕,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)以及手术结束至转入ICU间隔时间均明显延长〔PT(s):17.20(14.50,18.63)比14.65(13.90,16.23),APTT(s):45.15(38.68,55.15)比39.45(36.40,45.70),手术结束至转入ICU间隔时间(h):39.2(0.7,128.9)比0.7(0.3,2.0),均P<0.01〕,而术后血红蛋白(Hb)、血小板计数(PLT)、前白蛋白(PA)、平均�Objective To investigate the risk factors that were associated with the death of elderly patients who were admitted to the intensive care unit(ICU)after elective abdominal surgery,and to find reliable and sensitive predictive indicators for early interventions and reducing the mortality.Methods A retrospective case-control study was conducted.The clinical data of elderly(age≥65 years old)patients after elective abdominal surgery admitted to the ICU of the Affiliated Hospital of Guizhou Medical University from January 1st 2016 to December 31st 2020 were collected,including the patient's gender,age,body mass index(BMI),medical history,American Society of Anesthesiologists(ASA)grades,surgical classification,intraoperative blood loss,duration of operation,interval time between end of operation and admission to the ICU,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and the worst laboratory examination results within 24 hours of ICU admission,the first blood gas analysis in ICU,the duration of invasive mechanical ventilation,and the length of ICU stay.Postoperative abdominal infection was evaluated by the pathogenic culture of peritoneal drainage fluid and clinical symptoms and signs.The patients were divided into death group and survival group based on clinical outcomes,and clinical data were compared between the two groups.Binary multivariate Logistic regression analysis was used to screen the risk factors of death,and the receiver operator characteristic curve(ROC curve)was plotted to analyze the predictive values of these risk factors.Results A total of 226 elderly patients with elective abdominal surgery were admitted to the ICU of our hospital during the past 5 years,of whom,two patients who did not undergo laboratory examinations within 24 hours of admission to the ICU were excluded.Finally,224 patients met the criteria,with 158 survivors and 66 deaths.Univariate analysis showed that:compared with survival group,APACHEⅡscore,blood lactate acid(Lac)and the proportion of postoperative abdomi

关 键 词：老年患者 择期手术 腹部外科术后 重症监护病房 治疗时机 预后 危险因素 危重症 

分 类 号：R459.7[医药卫生—急诊医学]