普通外科重症监护病房住院时间延长的预测因素

Predictors of Prolonged Length of Stay in General Surgical Intensive Care Unit.

作者信息

Kongsayreepong Suneerat, Lomarat Naruenart, Thamtanavit Sarawut, Sodapak Chaianan, Vongvises Torpong, Kueaphet Sutthima, Saeheng Suchada, Komoltri Chulaluk

出版信息

J Med Assoc Thai. 2016 Sep;99 Suppl 6:S47-S54.

PMID:29906079

Abstract

OBJECTIVE

The aims of this study were to explore the incidence, clinical factors, severity scores and outcome associated with prolonged length of intensive care unit (ICU) stay >3 days.

MATERIAL AND METHOD

This study was a prospective observational study on the noncardiac surgical patients who were admitted to surgical intensive care unit in a tertiary university hospital. The cardiothoracic, neurosurgical and traumatic surgical patients or the patients who died within the first 3 days of ICU admission were excluded. Patient demographic data, preoperative predictors and severity scores (APACHE II, APACHE III, SOFA, SAPS II and MODS scores) at day 1 and day 3 of ICU admission were recorded.

RESULTS

A total of 948 patients were observed. The incidence of prolonged ICU stay was 20.1%. Patients with prolonged ICU stay had significantly higher ventilator hours (p<0.001) and ICU length of stay (p<0.001). On the multivariable analysis model of preoperative variables, the significant predictors of prolonged ICU stay were preoperative serum albumin less than 2.6 mg/dL (p = 0.023), preoperative hematocrit less than 34% (p = 0.035), emergency surgery (p = 0.003), having surgical complications (p = 0.017), having anesthetic complications (p = 0.017), admission for respiratory support with or without unstable hemodynamic (p<0.001), and sepsis on ICU admission (p = 0.003). Regarding the multivariable analysis of severity scoring system, the significant severity predictors were found only the preoperative ASA class IV (p<0.001) and emergency ASA status (p<0.001).

CONCLUSION

About one-fifth of the study patients had prolonged ICU stay (>3 days). Low preoperative serum albumin (<2.6 mg/dL), low preoperative hematocrit (<34%), ASA physical status class IV, underwent emergency surgery, having anesthetic complications, surgical complications, sepsis on ICU admission, having respiratory support with or without unstable hemodynamic were significantly associated with prolonged ICU stay.

摘要

目的

本研究旨在探讨重症监护病房（ICU）住院时间延长超过3天的发生率、临床因素、严重程度评分及预后情况。

材料与方法

本研究是一项针对一所三级大学医院外科重症监护病房收治的非心脏手术患者的前瞻性观察研究。排除心胸外科、神经外科和创伤外科患者或在ICU入院后前3天内死亡的患者。记录患者的人口统计学数据、术前预测指标以及ICU入院第1天和第3天的严重程度评分（急性生理与慢性健康状况评分系统II [APACHE II]、APACHE III、序贯器官衰竭评估 [SOFA]、简化急性生理学评分II [SAPS II] 和多器官功能障碍综合征 [MODS] 评分）。

结果

共观察了948例患者。ICU住院时间延长的发生率为20.1%。ICU住院时间延长的患者呼吸机使用时间（p<0.001）和ICU住院时长（p<0.001）显著更长。在术前变量的多变量分析模型中，ICU住院时间延长的显著预测因素包括术前血清白蛋白低于2.6 mg/dL（p = 0.023）、术前血细胞比容低于34%（p = 0.035）、急诊手术（p = 0.003）、发生手术并发症（p = 0.017）、发生麻醉并发症（p = 0.017）、因呼吸支持入院且伴有或不伴有血流动力学不稳定（p<0.001）以及ICU入院时存在脓毒症（p = 0.003）。关于严重程度评分系统的多变量分析，仅发现术前美国麻醉医师协会（ASA）分级为IV级（p<0.001）和急诊ASA状态（p<0.001）是显著的严重程度预测因素。