Lobo Suzana Margareth, Rezende Ederlon, Knibel Marcos Freitas, Silva Nilton Brandão da, Páramo José Antonio Matos, Nácul Flávio, Mendes Ciro Leite, Assunção Murilo, Costa Filho Rubens Carmo, Grion Cíntia C, Pinto Sérgio Felix, Mello Patricia M Veiga de Carvalho, Maia Marcelo de Oliveira, Duarte Péricles Almeida Delfino, Gutierrez Fernando, Okabe Renata, Silva Junior João Manuel da, Carvalho Aline Affonso de, Lopes Marcel Rezende
Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
Serviço de Terapia Intensiva, Servidor Público Estadual.
Rev Bras Ter Intensiva. 2008 Dec;20(4):376-84.
Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit.
A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates.
Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%). Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53%).
Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.
由于医学上的重大突破以及人口老龄化加剧，术后有死亡风险的患者比例随时间不断增加。本研究旨在评估入住重症监护病房的非心脏外科手术患者的治疗结果及流行病学情况。
在21个重症监护病房开展了一项多中心、前瞻性、观察性队列研究。对2006年4月至6月期间入住参与研究的重症监护病房的885例成年外科手术患者进行了评估，最终纳入587例患者。排除标准包括创伤、心脏、神经、妇科、产科及姑息性手术。主要观察指标为术后并发症、重症监护病房死亡率及90天死亡率。
分别有66.4%和31.7%的患者接受了大手术和急诊手术。重症监护病房死亡率为15%，38%的患者出现术后并发症。最常见的并发症是感染或脓毒症（24.7%）。仅1.9%的患者被诊断为心肌缺血。术后死亡的患者中，共有94%在手术时有合并症（3.4±2.2）。多器官功能衰竭是主要死因（53%）。
脓毒症是接受非心脏手术患者发病的主要原因。在这一患者群体中，多器官功能衰竭是医院内最常见的死亡原因。
