Papadakis M A, Browner W S
Department of Medicine, University of California, San Francisco.
Am J Med. 1987 Oct;83(4):687-92. doi: 10.1016/0002-9343(87)90899-0.
In order to determine prognostic factors in noncardiac medical patients treated by mechanical ventilation in a Veterans Administration hospital, 78 patient records were reviewed. Disease severity was scored by the Acute Physiology and Chronic Health Evaluation (APACHE) II system. Physicians' prior impressions of prognostic factors were compared with the actual results of this study. Most patients were middle-aged men with respiratory diseases. Fifty-nine patients (76 percent) died in the hospital. Survivors of hospitalization and nonsurvivors had similar age, diagnoses, emergency intubations, duration of ventilation, and pH and oxygen tension after 24 hours of ventilation. However, only one of 31 patients with a serum albumin level of 2.5 g/dl or less at the initiation of mechanical ventilation survived (p less than 0.001). Of 24 patients requiring a fractional inspired oxygen concentration greater than 50 percent at 24 hours, none survived (p less than 0.005). At all APACHE II scores, the mortality rates documented in this study were higher than predicted. Physicians overestimated the impact of several variables, including age and presence of pneumonia, on mortality. At the San Francisco Veterans Administration Medical Center, a low serum albumin level may aid in the decision whether to begin mechanical ventilation, and a high fractional inspired oxygen concentration at 24 hours may aid in the decision regarding further aggressive care. These findings need to be validated in other patients before being applied. Conversely, certain older patients, and those undergoing emergency intubation or intubation for a prolonged time, may have as good a prognosis as patients without these factors.
为了确定在一家退伍军人管理局医院接受机械通气治疗的非心脏内科患者的预后因素，回顾了78份患者记录。疾病严重程度采用急性生理学与慢性健康状况评价系统（APACHE）Ⅱ进行评分。将医生之前对预后因素的判断与本研究的实际结果进行比较。大多数患者为患有呼吸系统疾病的中年男性。59名患者（76%）在医院死亡。住院幸存者和非幸存者在年龄、诊断、急诊插管、通气时间以及通气24小时后的pH值和氧分压方面相似。然而，在机械通气开始时血清白蛋白水平为2.5 g/dl或更低的31名患者中，只有1名存活（p<0.001）。在24小时时需要吸入氧分数浓度大于50%的24名患者中，无一存活（p<0.005）。在所有APACHEⅡ评分中，本研究记录的死亡率均高于预测值。医生高估了包括年龄和肺炎存在等几个变量对死亡率的影响。在旧金山退伍军人管理局医疗中心，低血清白蛋白水平可能有助于决定是否开始机械通气，而24小时时高吸入氧分数浓度可能有助于决定是否采取进一步积极治疗。这些发现需要在其他患者中得到验证后才能应用。相反，某些老年患者以及那些接受急诊插管或长时间插管的患者，可能与没有这些因素的患者预后一样好。
