我们引发的疾病：内科病房中的医源性疾病

The diseases we cause: Iatrogenic illness in a department of internal medicine.

作者信息

Madeira Sofia, Melo Miguel, Porto João, Monteiro Sílvia, Pereira de Moura J M, Alexandrino M B, Moura J J Alves

机构信息

Department of Internal Medicine - Medicina 2, University Hospital (HUC), Praceta Mota Pinto, 3000 Coimbra, Portugal.

出版信息

Eur J Intern Med. 2007 Sep;18(5):391-9. doi: 10.1016/j.ejim.2006.12.009. Epub 2007 Jun 27.

DOI:10.1016/j.ejim.2006.12.009

PMID:17693227

Abstract

BACKGROUND

The aim of this study was to estimate the incidence, main causes, and risk factors of iatrogenic disease occurring in a department of internal medicine.

METHODS

Over a 1-year period, physicians systematically filled out a 2-page questionnaire for all patients admitted to the ward. A database was created and the data were statistically analyzed. Patients undergoing immunosuppressive, chemo-, or radiation therapy were excluded. Missing data were completed by reviewing the patients' charts. The patients were then divided into two groups: those with and those without iatrogenic disease. The groups were compared using several parameters including gender, age, social features, days of hospitalization, associated illness, functional status, medical impression, prognosis, associated renal or liver function impairment, drugs taken daily, and outcome. In the group with iatrogenic disease, the type, severity, and predictability were also analyzed.

RESULTS

Of the 879 patients admitted to the ward, 445 completed questionnaires and were included in the study. A total of 102 patients (22.9%) developed 121 iatrogenic events. Forty-four patients (43.1%) were admitted for iatrogenic illness, 10 (9.8%) developed life-threatening events, and in 3 (6.8%) it was the cause of death. Fifty-eight patients (56.8%) registered 77 episodes of iatrogenic disease during their hospital stay, 20 (19.6%) developed life-threatening events, and 9 (11.7%) died, 4 (5.2%) of an iatrogenic cause (nosocomial infections). Significant differences were found in 20 out of 26 parameters studied (p<0.005 for all cases; 95% confidence interval). Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related, 80% of which was due to side effects or adverse reactions. Infection and metabolic and electrolyte disorders were the most frequent effects.

CONCLUSIONS

It is possible to identify risk factors for iatrogenic events. Chronically ill elderly inpatients are the main target of iatrogenic events.

摘要

背景

本研究旨在评估内科病房中医源性疾病的发生率、主要病因及危险因素。

方法

在为期1年的时间里，医生为所有入住该病房的患者系统填写一份两页的问卷。创建了一个数据库并对数据进行统计分析。接受免疫抑制、化疗或放疗的患者被排除在外。通过查阅患者病历完善缺失数据。然后将患者分为两组：患有医源性疾病的患者和未患医源性疾病的患者。使用包括性别、年龄、社会特征、住院天数、相关疾病、功能状态、医学印象、预后、相关肾功能或肝功能损害、每日服用药物及结局等多个参数对两组进行比较。在患有医源性疾病的组中，还对类型、严重程度及可预测性进行了分析。

结果

在入住该病房的879名患者中，445名完成问卷并纳入研究。共有102名患者（22.9%）发生了121起医源性事件。44名患者（43.1%）因医源性疾病入院，10名（9.8%）发生危及生命的事件，3名（6.8%）因医源性疾病死亡。58名患者（56.8%）在住院期间发生了77起医源性疾病事件，20名（19.6%）发生危及生命的事件，9名（11.7%）死亡，4名（5.2%）死于医源性原因（医院感染）。在所研究的26个参数中有20个存在显著差异（所有病例p<0.005；95%置信区间）。所有医源性疾病中18%为严重疾病，61.9%可预测，54.5%可避免，59%与药物相关，其中80%是由副作用或不良反应引起。感染以及代谢和电解质紊乱是最常见的影响。