Rubins H B, Moskowitz M A
Department of Medicine, Boston VA Medical Center, MA 02130.
J Gen Intern Med. 1990 Mar-Apr;5(2):104-9. doi: 10.1007/BF02600508.
To determine the frequency and nature of complications of care in the medical intensive care unit (MICU).
Prospective, observational study.
Seven-bed MICU in a teaching and referral VA hospital.
295 consecutive patients admitted to the MICU during a ten-month study period.
None.
Forty-two patients (14%, 95% confidence interval 13%, 16%) experienced one or more complications during their MICU stays. Compared with other MICU patients, those experiencing complications tended to be older (mean age +/- SD: 63.6 +/- 10.1 years vs 59.3 +/- 14.0 years, p less than 0.02) and more acutely ill (mean Acute Physiology Score +/- SD: 18.3 +/- 8.0 vs 12.5 +/- 8.0, p = 0.0001). These patients also had significantly longer MICU lengths of stay (mean +/- SD: 12.3 +/- 14.7 days vs 3.1 +/- 4 days, p less than 0.0001) and higher hospital mortality rates (67% vs 27%, p less than 0.001). The 67% mortality rate among patients with complications significantly exceeded the expected mortality rate of 46% (calculated from the APACHE risk equation).
Complications of care in the MICU are not rare and may independently contribute to in-hospital mortality. The potential for complications must be recognized when considering ICU care.
确定医学重症监护病房（MICU）护理并发症的发生率及性质。
前瞻性观察性研究。
一家教学及转诊型退伍军人管理局医院的七张床位的MICU。
在为期十个月的研究期间，连续295例入住MICU的患者。
无。
42例患者（14%，95%置信区间13%，16%）在MICU住院期间发生了一种或多种并发症。与其他MICU患者相比，发生并发症的患者往往年龄更大（平均年龄±标准差：63.6±10.1岁 vs 59.3±14.0岁，p<0.02）且病情更急（平均急性生理评分±标准差：18.3±8.0 vs 12.5±8.0，p = 0.0001）。这些患者的MICU住院时间也显著更长（平均±标准差：12.3±14.7天 vs 3.1±4天，p<0.0001），医院死亡率更高（67% vs 27%，p<0.001）。发生并发症患者的67%死亡率显著超过了预期死亡率46%（根据APACHE风险方程计算）。
MICU的护理并发症并不罕见，可能独立导致住院死亡率。在考虑ICU护理时，必须认识到并发症的可能性。
