Niskanen M, Reinikainen M, Kurola J
Department of Anaesthesiology and Intensive Care, ENT Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2007 Feb;51(2):151-7. doi: 10.1111/j.1399-6576.2006.01182.x. Epub 2006 Oct 31.
The aim of the study was to find out whether the characteristics of patients and the outcome from intensive care after cardiac arrest have changed over time.
Two nationwide databases were compared: (i) The Finnish National Intensive Care Study data in 1986-87 and (ii) data on 28,640 admissions to Finnish ICUs in 1999-2001. Patients whose reason for ICU admission was cardiac arrest were included. The former study included 604 patients treated in 18 medical and surgical ICUs in and the latter 1036 patients in 25 medical and surgical ICUs. Data on the components of Acute Physiology and Chronic Health Evaluation (APACHE II) were prospectively collected in both study periods. Logistic regression analysis was used to test the independent contribution of the study period on hospital mortality.
In 1986-87, patients were younger and the proportion of males was lower than in 1999-2001. The hospital mortality in 1986-87 was 61.3% and in 1999-2001 59.1% (P= 0.396). Among patients aged < 57 years, the hospital mortality in 1986-87 was 62.1% and in 1999-2001 48.8% (P < 0.01). In multivariate analysis, controlling for age, gender, Glasgow coma score (GCS), chronic health evaluation points and source of admission, treatment during 1986-87 was an independent predictor for hospital death among all patients (OR 1.273; 95% CI 1.015-1.594), those aged < 57 years (OR 1.959; 95% CI 1.270-3.021) and among males (OR 1.384; 95% CI 1.050-1.825).
Since the late 1980s, the outcome from intensive care after cardiac arrest may have improved especially among younger patients and males.
本研究旨在查明心脏骤停患者的特征以及心脏骤停后重症监护的结果是否随时间发生了变化。
对两个全国性数据库进行了比较：（i）1986 - 1987年芬兰国家重症监护研究数据，以及（ii）1999 - 2001年芬兰重症监护病房28640例入院患者的数据。纳入因心脏骤停入住重症监护病房的患者。前一项研究包括在18个内科和外科重症监护病房接受治疗的604例患者，后一项研究包括在25个内科和外科重症监护病房的1036例患者。在两个研究期间均前瞻性收集急性生理与慢性健康状况评价系统（APACHE II）的各项数据。采用逻辑回归分析来检验研究时间段对医院死亡率的独立影响。
1986 - 1987年的患者比1999 - 2001年的患者更年轻，男性比例更低。1986 - 1987年的医院死亡率为61.3%，1999 - 2001年为59.1%（P = 0.396）。在年龄小于57岁的患者中，1986 - 1987年的医院死亡率为62.1%，1999 - 2001年为48.8%（P < 0.01）。在多变量分析中，在控制年龄、性别、格拉斯哥昏迷评分（GCS）、慢性健康状况评价得分和入院来源后，1986 - 1987年的治疗是所有患者（比值比1.273；95%置信区间1.015 - 1.594）、年龄小于57岁的患者（比值比1.959；95%置信区间1.270 - 3.021）以及男性患者（比值比1.384；95%置信区间1.050 - 1.825）医院死亡的独立预测因素。
自20世纪80年代末以来，心脏骤停后重症监护的结果可能有所改善，尤其是在年轻患者和男性患者中。
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