重症监护病房药物过量患者复杂住院病程的独立危险因素。
Independent risk factors for a complicated hospital course in intensive care unit overdose patients.
作者信息
Tarui Takehiko, Yoshikawa Kei, Miyakuni Yasuhiko, Kaita Yasuhiko, Tamada Nao, Matsuda Taketo, Miyauchi Hiroshi, Yamada Kenji, Matsuda Takeaki, Yamaguchi Yoshihiro
机构信息
Department of Traumatology and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan.
出版信息
Acute Med Surg. 2014 Sep 17;2(2):98-104. doi: 10.1002/ams2.77. eCollection 2015 Apr.
AIM
The purpose of the present study was to identify risk factors associated with a complicated hospital course in overdose patients admitted to the intensive care unit.
METHODS
A total of 335 overdose patients were retrospectively studied in the surgical and medical intensive care unit of an academic tertiary hospital. Factors possibly associated with a complicated hospital course were evaluated. Complicated hospital course was defined as the occurrence of pneumonia, rhabdomyolysis, decubitus ulcer, nerve palsy, prolonged intubation, prolonged hospitalization, or death.
RESULTS
Of the 335 overdose patients, 93 (27.8%) had a complicated hospital course. Complicated hospital course was found to be associated with a high number of ingested pills (median, 135 [interquartile range, 78-240] versus 84 [53-134] tablets, < 0.0001), low Glasgow Coma Scale score on admission (7 [3-11] versus 13 [8-15], < 0.0001), and a high serum lactate level on admission (1.8 [1.0-3.0] versus 1.4 [0.9-2.0] mg/dL, < 0.01) on univariate analysis of these factors in patients with and without a complicated hospital course. The independent risk factors for a complicated hospital course identified on multivariate analysis were a high number of ingested pills (≥100 tablets), low admission Glasgow Coma Scale score (<9), and high serum lactate on admission (≥2.0 mg/dL). The probability of a complicated hospital course for patients with 0, 1, 2, or all 3 independent risk factors were 7%, 22%, 40%, and 81%, respectively.
CONCLUSION
The total number of ingested pills, admission Glasgow Coma Scale score, and serum lactate level on admission are predictive of a complicated hospital course in overdose patients admitted to the intensive care unit.
目的
本研究旨在确定入住重症监护病房的药物过量患者出现复杂住院病程的相关危险因素。
方法
在一所学术性三级医院的外科和内科重症监护病房对335例药物过量患者进行了回顾性研究。评估了可能与复杂住院病程相关的因素。复杂住院病程定义为发生肺炎、横纹肌溶解、压疮、神经麻痹、长时间插管、住院时间延长或死亡。
结果
在335例药物过量患者中，93例（27.8%）出现了复杂住院病程。在对有或无复杂住院病程的患者进行这些因素的单因素分析时，发现复杂住院病程与大量服药（中位数，135片[四分位间距，78 - 240片]对84片[53 - 134片]，<0.0001）、入院时格拉斯哥昏迷量表评分低（7分[3 - 11分]对13分[8 - 15分]，<0.0001）以及入院时血清乳酸水平高（1.8mg/dL[1.0 - 3.0mg/dL]对1.4mg/dL[0.9 - 2.0mg/dL]，<0.01）有关。多因素分析确定的复杂住院病程的独立危险因素为大量服药（≥100片）、入院格拉斯哥昏迷量表评分低（<9分）以及入院时血清乳酸水平高（≥2.0mg/dL）。具有0、1、2或所有3个独立危险因素患者出现复杂住院病程的概率分别为7%、22%、40%和81%。
结论
服药总数、入院格拉斯哥昏迷量表评分以及入院时血清乳酸水平可预测入住重症监护病房的药物过量患者的复杂住院病程。
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