急性自发性脑出血和创伤性脑损伤是重症监护病房（ICU）中危重病最常见的病因，且早期死亡率很高。
Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality.
作者信息
Zhou Ye-Ting, Tong Dao-Ming, Wang Shao-Dan, Ye Song, Xu Ben-Wen, Yang Chen-Xi
机构信息
Department of Surgery, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Neurology, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China.
出版信息
BMC Neurol. 2018 Aug 27;18(1):127. doi: 10.1186/s12883-018-1127-z.
BACKGROUND
Critical care covers multiple disciplines. However, the causes of critical illness in the ICU, particularly the most common causes, remain unclear. We aimed to investigate the incidence and the most common causes of critical illness and the corresponding early mortality rates in ICU patients.
METHODS
A retrospective cohort study was performed to examine critically ill patients (aged over 15 years) in the general ICU in Shuyang County in northern China (1/2014-12/2015). The incidences and causes of critical illnesses and their corresponding early mortality rates in the ICU were determined by an expert panel.
RESULTS
During the 2-year study period, 1,211,138 person-years (PY) and 1645 critically ill patients (mean age, 61.8 years) were documented. The median Glasgow Coma Scale (GCS) score was 6 (range, 3-15). The mean acute physiology and chronic health evaluation II (APACHE II) score was 21.2 ± 6.8. The median length of the ICU stay was 4 days (range, 1-29 days). The most common causes of critical illness in the ICU were spontaneous intracerebral hemorrhage (SICH) (26%, 17.6/100,000 PY) and traumatic brain injury (TBI) (16.8%, 11.4/100,000 PY). During the first 7 days in the ICU, SICH was the most common cause of death (42.2%, 7.4/10,000 PY), followed by TBI (36.6%, 4.2/100,000 PY). Based on a logistic analysis, older patients had a significantly higher risk of death from TBI (risk ratio [RR], 1.7; 95% CI, 1.034-2.635), heart failure/cardiovascular crisis (RR, 0.2; 95% CI, 0.083-0.484), cerebral infarction (RR, 0.15; 95% CI, 0.050-0.486), or respiratory failure (RR, 0.35; 95% CI, 0.185-0.784) than younger patients. However, the risk of death from SICH in the two groups was similar.
CONCLUSIONS
The most common causes of critical illness in the ICU were SICH and TBI, and both critical illnesses showed a higher risk of death during the first 7 days in the ICU.
背景
重症监护涉及多个学科。然而，重症监护病房（ICU）中危重病的病因，尤其是最常见的病因，仍不清楚。我们旨在调查ICU患者中危重病的发病率、最常见病因及相应的早期死亡率。
方法
进行一项回顾性队列研究，以检查中国北方沭阳县综合ICU中的危重病患者（年龄超过15岁）（2014年1月 - 2015年12月）。ICU中危重病的发病率、病因及其相应的早期死亡率由一个专家小组确定。
结果
在为期2年的研究期间，记录了1,211,138人年（PY）和1645例危重病患者（平均年龄61.8岁）。格拉斯哥昏迷量表（GCS）评分中位数为6（范围3 - 15）。急性生理与慢性健康状况评价II（APACHE II）评分均值为21.2 ± 6.8。ICU住院时间中位数为4天（范围1 - 29天）。ICU中危重病最常见的病因是自发性脑出血（SICH）（26%，17.6/100,000 PY）和创伤性脑损伤（TBI）（16.8%，11.4/100,000 PY）。在ICU的前7天，SICH是最常见的死亡原因（42.2%，7.4/10,000 PY），其次是TBI（36.6%，4.2/100,000 PY）。基于逻辑分析，老年患者因TBI（风险比[RR]，1.7；95%置信区间，1.034 - 2.635）、心力衰竭/心血管危机（RR，0.2；95%置信区间，0.083 - 0.484）、脑梗死（RR，0.15；95%置信区间，0.050 - 0.486）或呼吸衰竭（RR，0.35；95%置信区间，0.185 - 0.784）死亡的风险显著高于年轻患者。然而，两组中因SICH死亡的风险相似。
结论
ICU中危重病最常见的病因是SICH和TBI，并且这两种危重病在ICU的前7天均显示出较高的死亡风险。
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