Fowler Robert A, Filate Woganee, Hartleib Michael, Frost David W, Lazongas Chris, Hladunewich Michelle
Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Curr Opin Crit Care. 2009 Oct;15(5):442-9. doi: 10.1097/MCC.0b013e3283307a12.
The article reviews and speculates on potential mechanisms underlying sex-related differences in admission patterns, care delivery and outcome of critical illness.
Evidence from many countries suggests men are more commonly admitted to intensive care units than are women, and may be more likely to receive aggressive life support. These differences may be confounded by differences in incidence of conditions leading to critical illness, such as acute lung injury and sepsis, both more common among men, or to differences in provision of medical or surgical care that require intensive care unit. There may be different decision-making by patients or decision makers that is dependent upon age and sex of the patient and relation to the surrogate. It is unclear whether differences exist in clinical outcomes; if they do, the magnitude may be greatest among older patients. We describe potential biologic rationales and review animal models. Finally, we explore sex-based differences in the inclusion of men and women in clinical research that underlie our understanding of critical illness.
Sex differences in incidence of critical illness and provision of care exist but it is unclear whether they relate to differences in risk factors, or differences in decision-making among patients, surrogates or healthcare professionals.
本文回顾并推测了危重病患者在入院模式、治疗方式及预后方面存在性别差异的潜在机制。
许多国家的证据表明，男性比女性更常入住重症监护病房，且更有可能接受积极的生命支持治疗。这些差异可能因导致危重病的疾病发生率不同而混淆，如急性肺损伤和脓毒症在男性中更为常见，或者因需要重症监护病房的医疗或外科治疗的差异而产生。患者或决策者可能会根据患者的年龄、性别以及与代理人的关系做出不同的决策。目前尚不清楚临床结局是否存在差异；如果存在差异，在老年患者中差异可能最大。我们描述了潜在的生物学原理并回顾了动物模型。最后，我们探讨了临床研究中纳入男性和女性的性别差异，这些差异构成了我们对危重病理解的基础。
危重病的发病率和治疗存在性别差异，但尚不清楚这些差异是否与风险因素的差异有关，或者与患者、代理人或医护人员的决策差异有关。
