Schneider C P, Wolf H, Küchenhoff H, Jauch K-W, Hartl W H
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Chirurg. 2006 Aug;77(8):700-8. doi: 10.1007/s00104-006-1204-5.
For critically ill medical patients until the year 2000, increases in patient age and severity of disease but also acute prognosis have been described. Since then, further improvement appears possible. Several controlled studies have recently demonstrated that acute mortality may be further lowered by new adjuvant therapies such as aggressive glycemic control. However, it is still unknown whether demographic changes and progress in intensive care can be reproduced in surgical critically ill patients outside of a controlled trial setting.
We performed a retrospective, observational cohort study using data prospectively collected from the surgical intensive care unit (ICU) of the LMU Department of Surgery in Munich, Germany, Grosshadern Campus, from March 1 1993 through February 28 2005. Since 1999 we have successively introduced a variety of new therapies to daily routine. A cohort of 5,495 patients was analysed.
We identified reduced ICU mortality during the observation period, although age rose simultaneously and disease severity remained constant. Results from multivariate analysis suggest that improvements in prognosis essentially result from the implementation of new therapies after 2001. After adjusting for more than 20 covariables, treatment received after 2001 was identified as an independent factor linked with reduced risk of death.
General demographic trends and progress in intensive care can be demonstrated also in unselected surgical cohorts. Furthermore, the results here confirm the efficacy of new therapeutic modifications in routine therapy.
对于2000年以前的重症医学患者，已观察到患者年龄增长、疾病严重程度增加以及急性预后情况。自那时起，似乎还有进一步改善的可能。最近的几项对照研究表明，积极的血糖控制等新辅助治疗可进一步降低急性死亡率。然而，在非对照试验环境下，外科重症患者是否能再现人口结构变化和重症监护进展仍不清楚。
我们进行了一项回顾性观察队列研究，使用的数据是从德国慕尼黑路德维希 - 马克西米利安大学外科重症监护病房（ICU）前瞻性收集的，该病房位于慕尼黑的格罗斯哈登校区，时间跨度为1993年3月1日至2005年2月28日。自1999年起，我们陆续将多种新疗法引入日常治疗中。对5495例患者组成的队列进行了分析。
我们发现，在观察期内ICU死亡率有所降低，尽管患者年龄同时上升且疾病严重程度保持不变。多变量分析结果表明，预后改善主要源于2001年后新疗法的实施。在对20多个协变量进行调整后，2001年后接受的治疗被确定为与死亡风险降低相关的独立因素。
在未经选择的外科队列中也能证明一般人口趋势和重症监护的进展。此外，这里的结果证实了常规治疗中新型治疗改进措施的疗效。
