外科重症监护病房延长治疗 7 年后的死亡率。

Mortality 7 years after prolonged treatment on a surgical intensive care unit.

机构信息

Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland.

Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland.

出版信息

Swiss Med Wkly. 2022 Apr 8;152:w30144. doi: 10.4414/smw.2022.w30144. eCollection 2022 Mar 28.

DOI:10.4414/smw.2022.w30144

PMID:35429233

Abstract

AIMS OF THE STUDY

Long-term intensive care treatment confers a substantial physical, psychological and social burden on patients, their relatives and the treatment team. It is essential to know the outcome of patients with long-term treatment and to establish factors that possibly can predict mortality. Only few Swiss studies have previously addressed this issue.

METHODS

This retrospective observational study at a Swiss tertiary academic medical care centre included patients who were treated for ≥7 consecutive days at the surgical intensive care unit (ICU) between 1 January 2011 and 31 December 2012. Follow-up ended on 30 September 2018.

RESULTS

Two-hundred and fifty patients were included, and three were lost to follow-up. Fifty-two patients (21.1%) died in the ICU, 25 (10.1%) after transfer to the normal ward. Thirty-one patients (12.5%) died within one year after the beginning of intensive care treatment. Altogether, the one-year mortality was 43.7% (108 patients). At the end of follow-up, 99 patients (40.1%) were still alive. Polytrauma patients represent a special group with a survival of more than 90%. Median patient age was 66 years (interquartile range 56-75); two thirds were men. Patients who died within one year of beginning treatment in the ICU were significantly older (median 71 vs 63 years, p <0.001), had a higher Charlson comorbidity index (mean 2.3 vs 1.2, p <0.001), a longer intensive care stay (median 13.9 vs 10.6 days, p = 0.001), a higher SAPS-II score (mean 52.7 vs 45.6, p = 0.001), a higher NEMS score (mean 1772.4 vs 1230.4, p <0.001) and more complications (mean 2.9 vs 2.0, p <0.001) than patients who survived at least 1 year. Those who died within 1 year more often developed pneumonia (50.9% vs 29.5%, p = 0.001), pleural empyema (13.0% vs 2.9%, p = 0.005), septic shock (51.9% vs 20.1%, p <0.001) or critical illness polyneuropathy (16.7% vs 2.9%, p <0.001). Moreover, they more frequently (30.6% vs 15.1%, p = 0.006) required a renal replacement therapy.

CONCLUSIONS

Long-term mortality of patients with prolonged intensive-care treatment is high. Scores combined with factors shown to be associated with an increased short- and long-term mortality can help to identify patients at risk for death within one year after ICU treatment.

摘要

目的

长期重症监护治疗会给患者、其家属和治疗团队带来巨大的身体、心理和社会负担。了解长期治疗患者的结局并确定可能预测死亡率的因素至关重要。之前仅有少数瑞士研究涉及这一问题。

方法

这项在瑞士一家三级学术医疗中心进行的回顾性观察性研究纳入了 2011 年 1 月 1 日至 2012 年 12 月 31 日期间在外科重症监护病房（ICU）接受连续治疗≥7 天的患者。随访于 2018 年 9 月 30 日结束。

结果

共纳入 250 例患者，其中 3 例失访。52 例（21.1%）患者在 ICU 死亡，25 例（10.1%）在转入普通病房后死亡。31 例（12.5%）患者在重症监护治疗开始后 1 年内死亡。总体而言，1 年死亡率为 43.7%（108 例）。随访结束时，99 例（40.1%）患者仍存活。多发伤患者是一个特殊群体，存活率超过 90%。患者中位年龄为 66 岁（四分位距 56-75）；三分之二为男性。在 ICU 治疗开始后 1 年内死亡的患者年龄显著更大（中位数 71 岁 vs 63 岁，p<0.001），合并症 Charlson 评分更高（均值 2.3 vs 1.2，p<0.001），重症监护治疗时间更长（中位数 13.9 天 vs 10.6 天，p=0.001），急性生理学与慢性健康状况评分系统 II 评分更高（均值 52.7 vs 45.6，p=0.001），神经肌肉阻滞评分更高（均值 1772.4 vs 1230.4，p<0.001），并发症更多（均值 2.9 vs 2.0，p<0.001）。与至少存活 1 年的患者相比，在 1 年内死亡的患者更常发生肺炎（50.9% vs 29.5%，p=0.001）、脓胸（13.0% vs 2.9%，p=0.005）、感染性休克（51.9% vs 20.1%，p<0.001）或危重病性多发性神经病（16.7% vs 2.9%，p<0.001）。此外，他们更常需要肾脏替代治疗（30.6% vs 15.1%，p=0.006）。