影响非心脏手术SICU老年患者预后的危险因素及临床特征分析  

Analysis of risk factors and clinical characteristics affecting the prognosis of elderly patients in the surgical intensive care unit after non-cardiac surgery

作　　者：徐敏[1] 李强[1] 陈峣[1] 张京岚[1] Xu Min;Li Qiang;Chen Yao;Zhang Jinglan(Department of Surgical Intensive Care Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院综合外科监护室,北京100029

出　　处：《中国中西医结合急救杂志》2024年第6期690-694,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：首都医科大学附属北京安贞医院高水平研究专项学科建设项目(2024AZC4006)。

摘　　要：目的通过分析近10年来非心脏外科重症监护病房(SICU)患者整体年龄的变化趋势,探讨影响非心脏手术SICU患者围术期死亡的危险因素。方法回顾性分析首都医科大学附属北京安贞医院2013年1月1日至2022年12月31日收治的12535例患者的临床资料,包括性别、年龄、基础疾病、入住SICU后机械通气、连续性肾脏替代治疗(CRRT)、脓毒症发生情况、留观时间及病死率,将患者按年龄分为<60岁(中青组)、60~80岁(老年组)和≥80岁(高龄组),比较不同年龄段3组上述临床资料的差异。以入住SICU期间发生的死亡为主要临床结局,采用单因素和多因素Logistic回归分析影响高龄组患者预后的危险因素。结果本院SICU 10年间患者平均年龄增加4.29岁,增速加快,尤其体现在2020至2022年。随着年龄的增长,CRRT比例、脓毒症发生率、病死率均逐渐增加,留观时间明显延长,中青组、老年组和高龄组3个年龄段组比较差异均有统计学意义〔CRRT比例:0.84%(44/5213)、1.42%(92/6477)、3.55%(30/845),脓毒症发生率:0.84%(44/5213)、1.13%(73/6477)、4.14%(35/845),留观时间(d):1.00(1.00,1.00)、1.00(1.00,1.00)、1.00(1.00,3.00),病死率:0.63%(33/5213)、0.97%(63/6477)、3.08%(26/845),均P<0.05〕;男性比例、冠心病、糖尿病和机械通气患者比例以老年组最高,中青组、老年组和高龄组3个年龄段组男性比例〔48.1%(2507/5213)、60.9%(3942/6477)、54.6%(461/845)〕、冠心病〔12.6%(656/5213)、39.4%(2549/6477)、37.5%(317/845)〕、高血压〔27.2%(1416/5213)、51.6%(3343/6477)、55.9%(472/845)〕、糖尿病〔10.7%(557/5213)、22.1%(1433/6477)、19.4%(164/845)〕和机械通气〔73.0%(3808/5213)、87.5%(5667/6477)、74.1%(626/845)〕患者比例比较差异亦均有统计学意义(均P<0.05)。高龄存活组患者高血压比例较死亡组明显增多〔56.5%(463/819)比34.6%(9/26),P<0.05〕,机械通气和CRRT比例及脓毒症发生率较死亡组明显降低〔机械通气:73.5%(60Objective By analyzing the trends in the overall age of patients in the surgical intensive care unit(SICU)over the past decade,to explore the risk factors influencing perioperative mortality in patients undergoing noncardiac surgery in the SICU.Methods A retrospective analysis was conducted on the clinical data of 12535 patients admitted to Beijing Anzhen Hospital,Capital Medical University,from 1 January,2013 to 31 December,2022,including gender,age,underlying diseases,mechanical ventilation after admission to SICU,continuous renal replacement therapy(CRRT),sepsis occurrence,detention time,and mortality.The patients were divided into<60 years old(young and middle-aged group),60-80 years old(aged group)and≥80 years old(elderly group)according to age,and the differences of the above clinical data in the 3 groups at different ages were compared.The main clinical outcome was death during admission to SICU.Univariate and multivariate Logistic regression were used to analyze the risk factors affecting the prognosis of elderly patients.Results Over the past 10 years,the average age of patients in the SICU of our hospital has increased by 4.29 years,with a notable acceleration in this trend observed in 2020-2022.As age increased,the proportion of patients receiving CRRT,the incidence of sepsis,and the mortality rate all gradually increased,while the length of stay was significantly prolonged,the differences among the young and middle-aged group,the aged group,and the elderly group were statistically significant[CRRT rates:0.84%(44/5213),1.42%(92/6477),3.55%(30/845);sepsis incidence rates were 0.84%(44/5213),1.13%(73/6477),and 4.14%(35/845);observation time(days):1.00(1.00,1.00),1.00(1.00,1.00),1.00(1.00,3.00);mortality rates:0.63%(33/5213),0.97%(63/6477),and 3.08%(26/845),all P<0.05].The proportions of male patients,as well as those with coronary artery disease,diabetes,and ventilator use,were highest in the aged group.Significant differences were observed across the three groups for male proportion[48.1%(2507/5213),6

关 键 词：外科重症监护病房 脓毒症 病死率 

分 类 号：R47[医药卫生—护理学]