重症监护病房社区获得性肺炎患者的早期康复与院内死亡率。
Early Rehabilitation and In-Hospital Mortality in Intensive Care Patients With Community-Acquired Pneumonia.
机构信息
Yusuke Sawada is a senior resident doctor, Yasuo Nakahara is a research associate, and Nobuhiko Haga is a professor, Department of Rehabilitation Medicine, University of Tokyo Hospital, Tokyo, Japan. Yusuke Sasabuchi is a project assistant professor, Department of Health Service Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Hiroki Matsui is an assistant professor and Hideo Yasunaga is a professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo. Kiyohide Fushimi is a professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan.
出版信息
Am J Crit Care. 2018 Mar;27(2):97-103. doi: 10.4037/ajcc2018911.
BACKGROUND
Community-acquired pneumonia is one of the most common infectious diseases and can be fatal. The benefits of early rehabilitation in intensive care units are known, but the association between early rehabilitation and in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units has not been studied.
OBJECTIVES
To study the association between early rehabilitation and the in-hospital mortality of patients with community- acquired pneumonia admitted to intensive care units, effects of early rehabilitation on unit and hospital lengths of stay, and total costs of hospitalization.
METHODS
A retrospective observational cohort study using a national inpatient database of patients with community-acquired pneumonia admitted to intensive care units in acute care hospitals in Japan from July 2011 through March 2014. Propensity score-matching analysis was used to compare outcomes between patients with and without early rehabilitation (within 2 days of admission).
RESULTS
Among 8732 eligible patients, propensity score matching created 972 pairs of patients with and without early rehabilitation. The early rehabilitation group had significantly lower in-hospital mortality than did the group without early rehabilitation (17.9% vs 21.9%, respectively; = .03). The groups did not differ significantly in intensive care unit or hospital lengths of stay or in total costs of hospitalization.
CONCLUSIONS
Early rehabilitation within 2 days of admission was associated with reduced in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units.
背景
社区获得性肺炎是最常见的传染病之一，可导致死亡。众所周知，重症监护病房（ICU）早期康复有益，但 ICU 收治的社区获得性肺炎患者早期康复与院内死亡率之间的关联尚未得到研究。
目的
研究 ICU 收治的社区获得性肺炎患者早期康复与院内死亡率之间的关联，以及早期康复对 ICU 入住时间和医院住院时间以及总住院费用的影响。
方法
这是一项回顾性观察性队列研究，使用了日本急性护理医院 ICU 收治的社区获得性肺炎患者的全国住院患者数据库，研究时间为 2011 年 7 月至 2014 年 3 月。采用倾向评分匹配分析比较了接受早期康复（入院后 2 天内）和未接受早期康复的患者的结局。
结果
在 8732 例符合条件的患者中，采用倾向评分匹配创建了 972 对接受早期康复和未接受早期康复的患者。早期康复组的院内死亡率明显低于未接受早期康复组（分别为 17.9%和 21.9%； =.03）。两组在 ICU 入住时间、医院住院时间或总住院费用方面无显著差异。
结论
入院后 2 天内的早期康复与 ICU 收治的社区获得性肺炎患者的院内死亡率降低相关。
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