Hartl Wolfgang H, Wolf Hilde, Schneider Christian P, Küchenhoff Helmut, Jauch Karl-Walter
Department of Surgery, Klinikum Grosshadern, Marchioninistr, 15, LMU Munich, D-81377 Munich, Germany.
Crit Care. 2007;11(3):R55. doi: 10.1186/cc5915.
Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis.
We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed.
The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival.
Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease.
多项队列研究表明，在过去15年中，未经挑选的重症患者的急性（短期）死亡率可能有所改善。目前尚不清楚这些益处是否也会影响慢性重症患者的急性和长期预后，以及与预后相关的决定因素。
我们对1993年3月至2005年2月收集的数据进行了回顾性分析。分析了一组连续390例需要重症监护治疗超过28天的外科患者。
重症监护病房（ICU）生存率为53.6%。ICU幸存者中1年、3年和5年生存率分别为61.8%、44.7%和37.0%。在对相关协变量进行调整后，1993年至1999年与1999年至2005年期间的急性和长期生存率无显著差异。急性预后取决于ICU住院期间的疾病严重程度和初始诊断。然而，只有后者与长期预后独立相关。高龄是短期和长期生存不良的独立预后决定因素。
在过去12年中，慢性重症外科患者的急性和长期预后保持不变。经过成功的手术干预和重症监护后，长期预后相当良好，主要由年龄和基础疾病决定。
