Singh N, Gayowski T, Wagener M M
VA Medical Center, Pittsburgh, Pennsylvania, USA.
Clin Transplant. 1997 Apr;11(2):113-20.
Determinants of outcome of intensive care unit (ICU) stay and quality of life in survivors was prospectively assessed in 50 consecutive liver transplant recipients requiring intensive care unit (ICU) management. Variables assessed included demographic, clinical and laboratory characteristics, measures of severity of illness (Child-Pugh, Apache II, and organ system failure scores) and quality of life measures (physical functioning, perceived quality of life, stress, depression, and adaptive coping). Overall ICU survival was 82% (41/50). Nonsurvivors had significantly higher acute physiology scores (p = 0.03). Apache II score (p = 0.03), Karnofsky score (p = 0.01) and serum bilirubin (p = 0.05) on admission than survivors. Nonalert mental status (p = 0.0002), hypothermia (p = 0.035) and hypotension (p = 0.027) on admission were significantly associated with mortality. During the ICU stay, requirement of mechanical ventilation (p = 0.02), duration of ventilation (p = 0.01), requirement of dialysis (p = 0.0005), development of pulmonary infiltrates (p = 0.0001) and infections in the ICU (p = 0.003) were significantly associated with mortality. Requirement of mechanical ventilation was an independently significant predictor of mortality (with mechanical ventilation, dialysis and infections in the logistic regression analysis model). There was no difference in post-discharge quality of life (as assessed by the perceived quality of life, stress, depression, and coping scores) in survivors of ICU stay as compared with patients who never required ICU care. Our study suggests that the ICU management can have a positive impact on outcome for liver transplant recipients. If they survive (and 82% did in this study), their quality of life is unaffected and as good as those whose postoperative course was not complicated by a critical illness requiring ICU care.
对50例连续需要重症监护病房（ICU）管理的肝移植受者进行前瞻性评估，以确定ICU住院结局的决定因素及幸存者的生活质量。评估的变量包括人口统计学、临床和实验室特征、疾病严重程度指标（Child-Pugh、Apache II和器官系统衰竭评分）以及生活质量指标（身体功能、感知生活质量、压力、抑郁和适应性应对）。ICU总体生存率为82%（41/50）。非幸存者入院时的急性生理学评分显著更高（p = 0.03）。Apache II评分（p = 0.03）、卡诺夫斯基评分（p = 0.01）和血清胆红素（p = 0.05）均高于幸存者。入院时无警觉精神状态（p = 0.0002）、体温过低（p = 0.035）和低血压（p = 0.027）与死亡率显著相关。在ICU住院期间，机械通气需求（p = 0.02）、通气时间（p = 0.01）、透析需求（p = 0.0005）、肺部浸润的发生（p = 0.0001）和ICU感染（p = 0.003）与死亡率显著相关。机械通气需求是死亡率独立的显著预测因素（在逻辑回归分析模型中与机械通气、透析和感染相关）。与从未需要ICU护理的患者相比，ICU住院幸存者出院后的生活质量（通过感知生活质量、压力、抑郁和应对评分评估）没有差异。我们的研究表明，ICU管理对肝移植受者的结局可产生积极影响。如果他们存活（本研究中有82%存活），其生活质量不受影响，与术后病程未因需要ICU护理的危重症而复杂化的患者一样好。
