Montuclard L, Garrouste-Orgeas M, Timsit J F, Misset B, De Jonghe B, Carlet J
Service de Réanimation Polyvalente, Fondation Hôpital Saint Joseph, Paris, France.
Crit Care Med. 2000 Oct;28(10):3389-95. doi: 10.1097/00003246-200010000-00002.
To examine the outcome, functional autonomy, and quality of life of elderly patients (> or = 70 yrs old) hospitalized for >30 days in an intensive care unit (ICU).
Prospective cohort study.
A ten-bed, medical-surgical ICU in a 460-bed, acute care, tertiary, university hospital.
A consecutive cohort of 75 patients, >70 yrs old, admitted to the ICU from January 1, 1993, to August 1, 1998, for >30 days.
None.
Severity at admission and of the underlying disease was estimated according to the Simplified Acute Physiologic Score (SAPS II), the Organ Dysfunction and/or Infection (ODIN) score, the McCabe score, and the Knaus classification. Therapeutic intensity was measured through the French Omega scoring system. All patients were mechanically ventilated during their ICU stay. Outcome measurements were made by two cross-sectional studies using telephone interviews on the first week of September 1996 and 1998 with a questionnaire including measures of functional capacity by Katz's Activities of Daily Living, modified Patrick's Perceived Quality of Life score, and the Nottingham Health Profile. The survival rate was 67% in the ICU and 47% in the hospital. A total of 30 patients were alive and able to participate in at least one of the cross-sectional studies. Independence in activities of daily living was decreased significantly after the ICU stay, except for feeding. However, most of the 30 patients remained independent (class A of the Activities of Daily Living index) with the possibility of going home. Perceived Quality of Life scores remained good, even if the patients estimated a decrease in their quality of life for health and memory. Return to society appeared promising regarding patient self respect and happiness with life. The estimated cost by survivor was of 55,272 EUR ($60,246 US).
This study suggests that persistent high levels of ICU therapeutic intensity were associated with a reasonable hospital survival in elderly patients experiencing prolonged mechanical ventilatory support. These patients presented a moderate disability that influenced somewhat their perceived quality of life. These results are sufficient to justify prolonged ICU stays for elderly patients.
研究在重症监护病房（ICU）住院超过30天的老年患者（≥70岁）的预后、功能自主性和生活质量。
前瞻性队列研究。
一家拥有460张床位的急性护理三级大学医院中的一个设有10张床位的内科-外科ICU。
1993年1月1日至1998年8月1日期间连续入选ICU且年龄大于70岁、住院超过30天的75例患者。
无。
根据简化急性生理评分（SAPS II）、器官功能障碍和/或感染（ODIN）评分、麦凯布评分和克瑙斯分类法评估入院时及基础疾病的严重程度。通过法国欧米伽评分系统测量治疗强度。所有患者在ICU住院期间均接受机械通气。在1996年和1998年9月的第一周，通过两次横断面研究进行预后测量，采用电话访谈方式，使用包含通过卡茨日常生活活动能力量表测量的功能能力、改良帕特里克生活质量感知评分以及诺丁汉健康状况量表的问卷。ICU的生存率为67%，医院的生存率为47%。共有30例患者存活且能够参与至少一项横断面研究。ICU住院后，除进食外，日常生活活动的独立性显著下降。然而，这30例患者中的大多数仍保持独立（日常生活活动指数A类）并有回家的可能。生活质量感知评分仍然良好，即使患者估计其健康和记忆力方面的生活质量有所下降。就患者的自尊和生活幸福感而言，回归社会前景乐观。幸存者的估计费用为55,272欧元（60,246美元）。
本研究表明，在接受长时间机械通气支持的老年患者中，持续高水平的ICU治疗强度与合理的医院生存率相关。这些患者存在中度残疾，对其生活质量感知有一定影响。这些结果足以证明老年患者在ICU延长住院时间是合理的。
