Papadakis M A, Lee K K, Browner W S, Kent D L, Matchar D B, Kagawa M K, Hallenbeck J, Lee D, Onishi R, Charles G
Department of Medicine, University of California, School of Medicine, San Francisco.
West J Med. 1993 Dec;159(6):659-64.
In this Department of Veterans Affairs cooperative study, we examined predictors of in-hospital and 1-year mortality of 612 mechanically ventilated patients from 6 medical intensive care units in a retrospective cohort design. The outcome variable was vital status at hospital discharge and after 1 year. The results showed that 97% of patients were men, the mean age was 63 +/- 11 years (SD), and hospital mortality was 64% (95% confidence interval, 60% to 68%). Within the next year, an additional 38% of hospital survivors died, for a total 1-year mortality of 77% (95% confidence interval, 73% to 80%). Hospital and 1-year mortality, respectively, for patients older than 70 years was 76% and 94%, for those with serum albumin levels below 20 grams per liter it was 92% and 96%, for those with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score greater than 35 it was 91% and 98%, and for patients who were being mechanically ventilated after cardiopulmonary resuscitation it was 86% and 90%. The mortality ratio (actual mortality versus APACHE II-predicted mortality) was 1.15. Conclusions are that patient age, APACHE II score, serum albumin levels, or the use of cardiopulmonary resuscitation may identify a subset of mechanically ventilated veterans for whom mechanical ventilation provides little or no benefit.
在这项退伍军人事务部合作研究中，我们采用回顾性队列设计，对来自6个医疗重症监护病房的612例机械通气患者的院内及1年死亡率的预测因素进行了研究。结局变量为出院时及1年后的生命状态。结果显示，97%的患者为男性，平均年龄为63±11岁（标准差），院内死亡率为64%（95%置信区间，60%至68%）。在接下来的一年中，另有38%的医院幸存者死亡，1年总死亡率为77%（95%置信区间，73%至80%）。70岁以上患者的院内及1年死亡率分别为76%和94%，血清白蛋白水平低于20克/升的患者分别为92%和96%，急性生理与慢性健康状况评分II（APACHE II）大于35分的患者分别为91%和98%，心肺复苏后接受机械通气的患者分别为86%和90%。死亡率比值（实际死亡率与APACHE II预测死亡率之比）为1.15。结论是，患者年龄、APACHE II评分、血清白蛋白水平或心肺复苏的使用可能识别出一部分机械通气的退伍军人，对于他们而言，机械通气几乎没有益处或根本没有益处。
