入住ICU危重化疗患者的临床特征及预后影响因素分析  

Analysis of clinical features and prognostic factors of critically ill patients receiving chemotherapy admitted to ICU

作　　者：郑海燕[1] 刘京 赵悦秋 施钰岚[1] Zheng Haiyan;Liu Jing;Zhao Yueqiu;Shi Yulan(Department of Nursing,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院护理部,浙江杭州310009

出　　处：《实用肿瘤杂志》2023年第4期354-359,共6页Journal of Practical Oncology

基　　金：浙江省教育厅科研项目(Y202043445)。

摘　　要：目的分析入住重症监护病房(intensive care unit,ICU)危重化疗患者的临床特征并分析其预后的影响因素。方法收集2013年1月至2023年4月入住浙江大学医学院附属第二医院ICU的161例危重化疗患者的临床资料。分析患者的基本信息、入住ICU时急性生理学与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)、基础疾病、入住ICU病因、主要救治措施及实验室检查结果等。所有患者的数据均为入住ICU后首次采集的数据。按《重症医学科建设与管理指南(试行)》的ICU出科标准作为短期结局标准,将患者分为好转组(n=115)与未好转组(n=46)。两组数据经单因素分析之后进行二元logistic回归分析,确定入住ICU的危重化疗患者预后的相关影响因素。结果纳入的161例危重化疗患者中,血液系统恶性肿瘤46例(28.6%),肝恶性肿瘤36例(22.4%),结直肠恶性肿瘤25例(15.5%),肺恶性肿瘤16例(9.9%)。好转组和未好转组APACHEⅡ评分、糖尿病、感染、休克、使用机械通气、动脉血氧分压和D-二聚体等方面比较,差异均具有统计学意义(均P<0.05)。二元logistic回归分析显示,APACHEⅡ评分(OR=1.165,95%CI:1.049~1.293,P=0.004)和动脉血氧分压(OR=0.983,95%CI:0.967~0.999,P=0.039)是患者预后的独立影响因素。结论对于入住ICU的危重化疗患者,APACHEⅡ评分和动脉血氧分压是患者预后的独立影响因素。Objective To analyze the clinical features and prognostic factors of critically ill patients receiving chemotherapy admitted to the intensive care unit(ICU).Methods Clinical data of 161 patients admitted to ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to April 2023 were collected.Patients'basic information,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores at ICU admission,underlying conditions,causes of ICU admission,main treatment measures and labo ratory indicators were analyzed.Data of all patients were collected for the first time after admission to ICU.Using the ICU discharge criteria in the Guidelines for the Construction and Management of Critical Care Medicine(Trial)as the short-term outcome standard,the patients were divided into the improved group(n=115)and the non-improved group(n=46).After univariate analysis of the data between the two groups,binary logistic regression analysis was performed to determine the relevant influencing factors for the prognosis of critically ill patients receiving chemotherapy admitted to the ICU.Results Among the included 161 patients,46 cases(28.6%)had hematologic malignancies,36 cases(22.4%)liver malignancies,25 cases(15.5%)colorectal malignancies,and 16 cases(9.9%)lung malignancies.There were statistically significant differences in APACHEⅡscore,diabetes mellitus,infection,shock,use of mechanical ventilation,arterial oxygen partial pressure(PaO2)and D-dimer between the two groups(all P<0.05).Binary logistic regression analysis showed that APACHEⅡscore(OR=1.165,95%CI:1.049-1.293,P=0.004)and PaO2(OR=0.983,95%CI:0.967-0.999,P=0.039)were the independent prognostic factors.Conclusions APACHEⅡscore and PaO2 are two independent prognostic factors for critically ill patients receiving chemotherapy admitted to the ICU.

关 键 词：肿瘤 化疗 重症监护病房 预后 

分 类 号：R730.53[医药卫生—肿瘤]