Reintam Annika, Parm Pille, Redlich Uwe, Tooding Liina-Mai, Starkopf Joel, Köhler Friedrich, Spies Claudia, Kern Hartmut
General Intensive Care Unit, Tartu University Clinics, Tartu, Estonia.
BMC Gastroenterol. 2006 Jun 22;6:19. doi: 10.1186/1471-230X-6-19.
While gastrointestinal problems are common in ICU patients with multiple organ failure, gastrointestinal failure has not been given the consideration other organ systems receive. The aim of this study was to evaluate the incidence of gastrointestinal failure (GIF), to identify its risk factors, and to determine its association with ICU mortality.
A retrospective analysis of adult patients (n = 2588) admitted to three different ICUs (two ICUs at the university hospital Charité-Universitätsmedizin Berlin, Germany and one at Tartu University Clinics, Estonia) during the year 2002 was performed. Data recorded in a computerized database were used in Berlin. In Tartu, the data documented in the patients' charts was retrospectively transferred into a similar database. GIF was defined as documented gastrointestinal problems (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. ICU mortality, length of stay, and duration of mechanical ventilation were assessed as outcome parameters.
GIF was identified in 252 patients (9.7% of all patients). Only 20% of GIF patients were identifiable at admission. GIF was related to significantly higher mortality (43.7% vs. 5.3% in patients without GIF), as well as prolonged length of ICU stay (10 vs. 2 days) and mechanical ventilation (8 vs. 1 day), p < 0.001, respectively. Patients' profile (emergency surgical or medical), APACHE II and SOFA scores and the use of catecholamines at admission were identified as independent risk factors for the development of GIF. Development of GIF during ICU stay was an independent predictor for death.
Gastrointestinal failure represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay and mechanical ventilation.
虽然胃肠道问题在多器官功能衰竭的重症监护病房（ICU）患者中很常见，但胃肠道衰竭并未得到像其他器官系统那样的重视。本研究的目的是评估胃肠道衰竭（GIF）的发生率，确定其危险因素，并确定其与ICU死亡率的关联。
对2002年入住三个不同ICU（德国柏林夏里特大学医学中心的两个ICU和爱沙尼亚塔尔图大学诊所的一个ICU）的成年患者（n = 2588）进行回顾性分析。柏林使用计算机数据库中记录的数据。在塔尔图，患者病历中记录的数据被回顾性地转入类似的数据库。GIF被定义为患者在ICU住院期间任何时间段的数据中记录的胃肠道问题（食物不耐受、胃肠道出血和/或肠梗阻）。评估ICU死亡率、住院时间和机械通气时间作为结局参数。
252例患者被诊断为GIF（占所有患者的9.7%）。入院时只有20%的GIF患者可被识别。GIF与显著更高的死亡率（43.7%对无GIF患者的5.3%）、更长的ICU住院时间（10天对2天）和机械通气时间（8天对1天）相关，p均<0.001。患者的特征（急诊手术或内科）、急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分以及入院时使用儿茶酚胺被确定为GIF发生的独立危险因素。ICU住院期间发生GIF是死亡的独立预测因素。
胃肠道衰竭是一个相关的临床问题，伴随着死亡率增加、ICU住院时间延长和机械通气时间延长。
