Maurette P, Valentin M L
Département d'anesthésie-réanimation, Hôpital Pellegrin, Bordeaux.
Agressologie. 1990;31(10):743-5.
High medical environment in our society is related to an increase of intensive care in old patients. This situation could be looked unappropriate trying to survive people who are finishing their life. An appropriate medical evaluation and management is thus necessary in order to quantifie as fairly as possible both prognosis and specific risk. Factors at the source of mortality in elderly patients are multiple and additive. However two classes of risk can be distinguished. On the one hand some of the risk factors are intrinsic depending on the patient (i.e., neurologic impairement, age, severity of acute illness, previous health status). On the other hand some of the risk are extrinsic related to medical environment (i.e. length of stay in intensive care units, care quality...). This latter risks are improveable and thus are important to be pinpointed. Time is also powerful to assess the best prediction of outcome in old patient. Unlikely mortality rate in elderly is twofold higher (about 35%) as compared as young patients. Evaluation of intensive care unit outcome on 6 months survival make this rate worse as 10% to 20% secondary died. However most of the published studies show that duration in intensive care is similar undepending of age and outcome of the patient. It is also noted that quality of live after intensive care is the same in young or old patient. It is concluded that individual's and society's views concerning cost and effectiveness of intensive care in old patient do not always coincide with objective results. If medical motivation has to be preserved, specific care strategy remained to be established.
我们社会中的高医疗环境与老年患者重症监护的增加有关。这种情况可能被认为不合适，试图让那些生命即将结束的人存活下来。因此，有必要进行适当的医学评估和管理，以便尽可能公平地量化预后和特定风险。老年患者死亡的源头因素是多方面且相互叠加的。然而，可以区分出两类风险。一方面，一些风险因素是内在的，取决于患者本身（即神经功能损害、年龄、急性疾病的严重程度、先前的健康状况）。另一方面，一些风险是外在的，与医疗环境相关（即重症监护病房的住院时间、护理质量……）。后一种风险是可以改善的，因此找出这些风险很重要。时间对于评估老年患者预后的最佳预测也很关键。老年患者的死亡率比年轻患者高出两倍（约35%）。对重症监护病房6个月生存率的评估显示，由于继发死亡，这一比率恶化至10%至20%。然而，大多数已发表的研究表明，重症监护的持续时间与患者的年龄和预后无关。还应注意的是，重症监护后年轻或老年患者的生活质量是相同的。结论是，个人和社会对于老年患者重症监护的成本和效益的看法并不总是与客观结果一致。如果要保持医疗动机，仍需制定具体的护理策略。
