McGrath J C, Wagner W H, Shabot M M
The Cedars-Sinai Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 1996 Oct;62(10):811-4.
The purpose was to determine the valid indications for Surgical Intensive Care Unit (SICU) admission after carotid endarterectomy (CEA). The indications for admission to the SICU after CEA were studied over a 3-year period (4/89-3/92). Absolute indications for ICU admission (AIA) included mechanical ventilation, a pulmonary artery catheter, and intravenous vasoactive or antiarrhythmic drug infusion. Patients were grouped according to presence of an AIA (Group A), absence of an AIA and a one day SICU length of stay (Group B), or absence of an AIA and a SICU length of stay > 1 day (Group C). A total of 305 patients were admitted to the SICU during the study. There were 55 patients in Group A. Of the 250 patients without an AIA, 239 were in Group B and 11 comprised Group C. Group A patients had a significantly higher severity of illness compared with Groups B and C (P < 0.05). Group B patients demonstrated no need for SICU care. Group C patients received ongoing SICU care due to postoperative neurological changes, arrhythmias, angina, incisional bleeding, vocal cord paresis, and unavailability of a ward room. None of these conditions was life-threatening, and only vocal cord paresis would have required SICU admission. Two patients in Group A died; no patients died in Group B or C. Only patients with an AIA, perioperative neurological changes, or early hemodynamic instability require SICU admission after CEA. An observation period in the recovery room allows for selection of nearly all patients who will eventually require SICU care.
目的是确定颈动脉内膜切除术（CEA）后入住外科重症监护病房（SICU）的有效指征。在3年期间（1989年4月至1992年3月）对CEA术后入住SICU的指征进行了研究。入住ICU的绝对指征（AIA）包括机械通气、肺动脉导管以及静脉输注血管活性药物或抗心律失常药物。根据是否存在AIA将患者分组（A组），不存在AIA且SICU住院时间为1天的患者（B组），或不存在AIA且SICU住院时间>1天的患者（C组）。研究期间共有305例患者入住SICU。A组有55例患者。在250例无AIA的患者中，239例属于B组，11例属于C组。与B组和C组相比，A组患者的疾病严重程度显著更高（P<0.05）。B组患者显示无需SICU护理。C组患者因术后神经功能改变、心律失常、心绞痛、切口出血、声带麻痹以及无病房床位而接受持续的SICU护理。这些情况均无生命危险，只有声带麻痹需要入住SICU。A组有2例患者死亡；B组和C组无患者死亡。CEA术后只有存在AIA、围手术期神经功能改变或早期血流动力学不稳定的患者需要入住SICU。在恢复室的观察期能够筛选出几乎所有最终需要SICU护理的患者。
