机械通气治疗的重症脑卒中患者的长期结局。

Long-term Outcomes of Critically Ill Patients With Stroke Requiring Mechanical Ventilation.

机构信息

Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.

出版信息

Am J Crit Care. 2019 Nov;28(6):477-480. doi: 10.4037/ajcc2019310.

DOI:10.4037/ajcc2019310

PMID:31676523

Abstract

BACKGROUND

Data on outcomes of critically ill patients requiring mechanical ventilation at the onset of stroke are limited.

OBJECTIVE

To assess the hospital and long-term functional outcomes of patients with stroke who require mechanical ventilation.

METHODS

This retrospective single-center cohort study performed from 1994 to 2008 involved adult patients within 7 days of stroke onset and who required intensive care unit admission and mechanical ventilation.

RESULTS

A total of 274 patients requiring mechanical ventilation at the onset of stroke were analyzed. Indications for intubation included coma in 195 patients (71%). The median (interquartile range) score on the Glasgow Coma Scale at admission to the intensive care unit was 6 (3-9). Forty-four patients (16%) had sepsis at intensive care unit admission. The overall hospital mortality rate was 53%. After adjustment for confounders, severity of illness at admission as assessed by the Simplified Acute Physiology Score II (odds ratio, 1.07; 95% CI, 1.05-1.10), anisocoria (odds ratio, 5.26; 95% CI, 1.76-15.80), and sepsis at intensive care unit admission (odds ratio, 0.40; 95% CI, 0.19-0.85) were associated with outcome. At 1 year, median (interquartile range) modified Rankin Scale score was 6 (2-6). Only 89 patients (32%) exhibited mild to moderate neurologic impairment.

CONCLUSION

In this study, adult patients requiring mechanical ventilation at the onset of stroke experienced high 1-year mortality, with survivors having poor functional status.

摘要

背景

关于在中风发作时需要机械通气的危重症患者结局的数据有限。

目的

评估需要机械通气的中风患者的住院和长期功能结局。

方法

这项回顾性单中心队列研究于 1994 年至 2008 年进行，纳入了中风发作后 7 天内需要入住重症监护病房并接受机械通气的成年患者。

结果

共分析了 274 例在中风发作时需要机械通气的患者。插管的指征包括 195 例（71%）昏迷。入住重症监护病房时格拉斯哥昏迷量表（Glasgow Coma Scale）的中位数（四分位间距）评分为 6（3-9）。44 例（16%）在入住重症监护病房时患有败血症。总体住院死亡率为 53%。在调整混杂因素后，入院时严重程度评估的简化急性生理学评分 II（SAPS II）（比值比，1.07；95%置信区间，1.05-1.10）、瞳孔不等大（比值比，5.26；95%置信区间，1.76-15.80）和重症监护病房入院时的败血症（比值比，0.40；95%置信区间，0.19-0.85）与结局相关。1 年时，中位数（四分位间距）改良 Rankin 量表评分为 6（2-6）。仅有 89 例患者（32%）表现出轻度至中度神经功能缺损。