Department of Clinical Haematology, Nottingham University Hospitals-City Campus, Nottingham, UK.
Ann Hematol. 2010 May;89(5):505-12. doi: 10.1007/s00277-009-0853-0. Epub 2009 Oct 30.
Patients with haematological disorders have previously been considered to have poor outcomes following admission to intensive care units. Although a number of haematology centres from outside the UK have now demonstrated improved outcomes, the continuing perception of poor outcomes in this patient group continues to adversely affect their chances of being admitted to some intensive care units (ICUs). Over the past 10 years, there have been many advances within the disciplines of both haematology and intensive care medicine. This study was done to assess outcomes and the impact of an early warning scoring system (EWS) and early involvement of ICU outreach teams. One hundred five haematology patients (haematopoietic stem cell transplant (HSCT) or non-HSCT) had 114 admissions to ICU between April 2006 and August 2008 which coincided with hospital-wide implementation of EWS. The survival to ICU discharge was 56 (53%). Thirty-three (33%) patients were alive at 6 months giving a 1-year survival of 31%. Of the 39 HSCT patients, nine were post-autologous and 30 post-allogeneic transplant. The survival to ICU discharge was 22 (56%) with 14 (36%) patients alive at 6 months. One year survival was 36%. Prior to the introduction of EWS and critical care outreach team (2004), survival to ICU discharge was 44% which has increased to 53% (2006-2008). This is despite an increase in mechanical ventilation in 2006-2008 (50%) as compared to 2004 (32%).The improvement in ICU survivorship was even more prominent in HSCT patients (37% in 2004 versus 56% in 2006-2008). There was a trend towards decreasing Acute Physiology and Chronic Health Evaluation scores with time, suggesting appropriate patients being identified earlier and having timely escalation of their treatment.
患有血液系统疾病的患者以前被认为在入住重症监护病房后预后较差。尽管英国以外的一些血液学中心现在已经证明了更好的结果，但在这个患者群体中持续存在的不良预后的看法仍然对他们入住某些重症监护病房（ICU）的机会产生不利影响。在过去的 10 年中，血液学和重症监护医学领域都取得了许多进展。这项研究旨在评估预后以及早期预警评分系统（EWS）和 ICU 外展团队的早期介入的影响。2006 年 4 月至 2008 年 8 月期间，105 名血液科患者（造血干细胞移植（HSCT）或非 HSCT）共 114 次入住 ICU，恰逢全院范围内实施 EWS。存活至 ICU 出院的患者为 56 例（53%）。33 例（33%）患者在 6 个月时存活，1 年生存率为 31%。39 例 HSCT 患者中，9 例为自体移植后，30 例为异基因移植后。存活至 ICU 出院的患者为 22 例（56%），其中 14 例（36%）在 6 个月时存活。1 年生存率为 36%。在引入 EWS 和重症监护外展团队（2004 年）之前，存活至 ICU 出院的患者为 44%，而 2006-2008 年则增加到 53%。尽管 2006-2008 年机械通气的比例（50%）高于 2004 年（32%），但这一数字仍有所增加。HSCT 患者的 ICU 存活率的改善更为显著（2004 年为 37%，2006-2008 年为 56%）。随着时间的推移，急性生理学和慢性健康评估评分呈下降趋势，表明更早地识别出合适的患者，并及时对其进行治疗升级。
