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心脏外科患者在长时间重症监护后的生存和生活质量。

Survival and quality of life in cardiac surgery patients with prolonged intensive care.

机构信息

Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Ann Thorac Surg. 2010 Feb;89(2):490-5. doi: 10.1016/j.athoracsur.2009.09.073.

Abstract

BACKGROUND

The clinical outcome in discharged cardiac surgery patients after prolonged postoperative intensive care needs further investigation. The aim was to study survival, functional status, and quality of life in cardiac surgery patients with more than 10 days postoperative intensive care unit stay.

METHODS

We performed a population-based study including 4,086 cardiac surgery patients and identified 141 patients who had a postoperative intensive care unit stay of more than 10 days. Data regarding patients and outcome were collected, and all discharged patients alive in May 2008, or a family member, were contacted to assemble information regarding functional status and quality of life using the Karnofsky performance scale and the Short Form-36 questionnaire.

RESULTS

Early mortality was 33%. Risk factors for early mortality were advanced age and postoperative dialysis. Survival at 1, 3, and 5 years was 62%, 56%, and 52%, respectively. Ninety-five patients were discharged from the hospital, and during a mean follow-up of 1.9 years, 62% were readmitted at least once. In discharged patients, 65% had a Karnofsky score of 80 or more. We found significantly lower physical (39.7 versus 43.6; p = 0.03), and mental (44.1 versus 50.8; p = 0.001) scores in the study group compared with a reference group.

CONCLUSIONS

Early mortality was high, especially in patients who required dialysis. However, long-term survival and functional status were encouraging. Quality of life was worse compared with the general population in both physical and mental aspects, but the difference was moderate. Extensive efforts in this patient group seem reasonable despite high resource utilization.

摘要

背景

需要进一步研究延长术后重症监护后出院的心脏手术患者的临床结果。目的是研究心脏手术后患者在重症监护病房停留超过 10 天的生存、功能状态和生活质量。

方法

我们进行了一项基于人群的研究,纳入了 4086 例心脏手术患者,并确定了 141 例术后重症监护病房停留时间超过 10 天的患者。收集了有关患者和结局的数据,并联系了所有在 2008 年 5 月仍存活的出院患者或其家属,使用卡诺夫斯基绩效量表和简短表格-36 问卷收集有关功能状态和生活质量的信息。

结果

早期死亡率为 33%。早期死亡率的危险因素是年龄较大和术后透析。1 年、3 年和 5 年的生存率分别为 62%、56%和 52%。95 例患者从医院出院,平均随访 1.9 年后,有 62%的患者至少再次入院。在出院患者中,65%的卡诺夫斯基评分在 80 分或以上。与参考组相比,我们发现研究组的身体(39.7 对 43.6;p=0.03)和精神(44.1 对 50.8;p=0.001)评分明显较低。

结论

早期死亡率较高,尤其是需要透析的患者。然而,长期生存和功能状态令人鼓舞。与一般人群相比,身体和心理方面的生活质量都较差,但差异适中。尽管资源利用率较高,但对该患者群体进行广泛的治疗似乎是合理的。

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