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[非心脏手术后疾病严重程度评分系统与死亡率]

[Severity of disease scoring systems and mortality after non-cardiac surgery].

作者信息

Reis Pedro Videira, Sousa Gabriela, Lopes Ana Martins, Costa Ana Vera, Santos Alice, Abelha Fernando José

机构信息

Hospital de São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Porto, Portugal.

Hospital de São João, Serviço de Anestesiologia, Porto, Portugal.

出版信息

Braz J Anesthesiol. 2018 May-Jun;68(3):244-253. doi: 10.1016/j.bjan.2017.12.001. Epub 2018 Apr 5.

Abstract

BACKGROUND

Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery.

METHODS

Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann–Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI).

RESULTS

4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay.

CONCLUSION

Some factors influenced both surgical intensive care unit and hospital mortality.

摘要

背景

手术后死亡情况很常见,疾病严重程度评分系统用于预测。我们的目的是评估非心脏手术后死亡的预测因素。

方法

纳入2006年1月至2013年7月在我们外科重症监护病房住院的成年患者。采用曼-惠特尼检验、卡方检验或费舍尔精确检验进行单因素分析。进行逻辑回归以评估独立因素,并计算比值比和95%置信区间(95%CI)。

结果

共纳入4398例患者。外科重症监护病房的死亡率为1.4%,住院期间的死亡率为7.4%。外科重症监护病房死亡的独立预测因素为急性生理与慢性健康状况评分系统Ⅱ(APACHE II)(比值比=1.24);急诊手术(比值比=4.10)、血清钠(比值比=1.06)和入院时的吸入氧分数(FiO)(比值比=14.31)。入院时血清碳酸氢盐(比值比=0.89)被认为是一个保护因素。医院死亡的独立预测因素为年龄(比值比=1.02)、APACHE II(比值比=1.09)、急诊手术(比值比=1.82)、高风险手术(比值比=1.61)、入院时的FiO(比值比=1.02)、术后急性肾衰竭(比值比=1.96)、心率(比值比=1.01)和血清钠(比值比=1.04)。死亡患者在疾病严重程度评分系统中的得分更高,在外科重症监护病房的住院时间更长。

结论

一些因素对外科重症监护病房和医院死亡率均有影响。

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[Severity of disease scoring systems and mortality after non-cardiac surgery].[非心脏手术后疾病严重程度评分系统与死亡率]
Braz J Anesthesiol. 2018 May-Jun;68(3):244-253. doi: 10.1016/j.bjan.2017.12.001. Epub 2018 Apr 5.

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