Smythe M A, Melendy S, Jahns B, Dmuchowski C
Department of Pharmacy Practice, Wayne State University, Detroit, MI 48202.
Crit Care Med. 1993 Sep;21(9):1319-23. doi: 10.1097/00003246-199309000-00014.
To evaluate patterns of medication use in a medical intensive care unit (ICU) and to explore relationships between drug use, patient age, admitting diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, length of stay, and survival.
Combination prospective and retrospective study.
Medical ICU in a large teaching institution.
Patient admissions (n = 191) to a medical ICU during a 4-month study period.
The following data were collected: age, length of stay, diagnosis, physiologic variables necessary for APACHE II scores, medications administered, and survival.
The mean length of stay of the study patients was 5.2 +/- 9.8 days. Overall mortality rate was 33%. The mean age of survivors, 62.7 yrs, was significantly (p < .05) lower than that value for nonsurvivors (68.6 yrs). Postcardiopulmonary resuscitation (CPR) or -stroke patients had a mortality rate that was higher than the overall mortality rate (p < .05). APACHE II scores of > 19 were associated with a reduced survival rate when compared with the overall mortality rate. The mean daily and mean total number of medications administered per patient were 7.5 +/- 3.4 and 12.1 +/- 7.6, respectively. Antihypertensives/vasodilators and gastrointestinal prophylaxis medications were administered most commonly in 69% and 65% of patients, respectively. The median total drug use per patient was significantly greater in nonsurvivors vs. survivors (13 and 10, respectively, p < .02). There was a positive linear relationship between total medication use and log length of stay (r2 = .62). Patients admitted post-CPR or with seizures received the highest number of medications (p < .05).
Patients admitted to the medical ICU receive multiple medications from a variety of pharmacologic classes. Prolonged length of stay, certain admitting diagnoses, and death are associated with increased medication administration. Age, certain admitting diagnoses, and APACHE II scores are significantly related to survival.
评估内科重症监护病房（ICU）的用药模式，并探讨药物使用、患者年龄、入院诊断、急性生理与慢性健康状况评价系统（APACHE II）评分、住院时间和生存率之间的关系。
前瞻性与回顾性相结合的研究。
一所大型教学机构的内科ICU。
在为期4个月的研究期间，内科ICU收治的患者（n = 191例）。
收集以下数据：年龄、住院时间、诊断、APACHE II评分所需的生理变量、使用的药物以及生存情况。
研究患者的平均住院时间为5.2±9.8天。总死亡率为33%。存活者的平均年龄为62.7岁，显著低于非存活者（68.6岁，p < 0.05）。心肺复苏（CPR）后或中风患者的死亡率高于总死亡率（p < 0.05）。与总死亡率相比，APACHE II评分>19与生存率降低相关。每位患者每天使用药物的平均数量和药物使用总量分别为7.5±3.4和12.1±7.6。抗高血压药/血管扩张剂和胃肠道预防用药分别在69%和65%的患者中最常使用。非存活者每位患者的药物使用总量中位数显著高于存活者（分别为13和10，p < 0.02）。药物使用总量与住院时间的对数之间存在正线性关系（r2 = 0.62）。CPR后入院或癫痫发作的患者使用的药物数量最多（p < 0.05）。
入住内科ICU的患者接受多种来自不同药理类别的药物治疗。住院时间延长、某些入院诊断和死亡与用药增加有关。年龄、某些入院诊断和APACHE II评分与生存率显著相关。
