急诊重症监护室患者死亡的危险因素分析
|
摘要
目的探讨急诊重症监护室患者入院3 d死亡的危险因素。方法收集2017年1月至12月就诊于中国医科大学附属盛京医院急诊重症监护室患者资料,依据3 d预后将患者分为生存组与死亡组,记录患者性别、年龄、主要诊断、既往病史、住院时间、治疗结果、是否行机械通气、APACHEⅡ评分、血液生化指标。应用t检验、χ2检验、多因素logistic回归及ROC曲线分析患者死亡的危险因素。结果共纳入210例患者,生存组161例(76.7%),死亡组49例(23.3%)。多因素logistic回归分析显示,需要机械通气、APAHEⅡ评分高、低白蛋白血症及高乳酸血症是患者死亡的独立危险因素(均P <0.05)。ROC曲线分析显示,APACHEⅡ评分曲线下面积为0.909 (P <0.001),95%CI:0.864～0.954,判断预后的最佳临界值为19.5,敏感度及特异度分别为77.6%和88.2%;血清白蛋白曲线下面积为0.674 (P <0.001),95%CI:0.587～0.761,判断预后的最佳临界值为38.05 g/L,敏感度及特异度分别为85.7%和47.8%;血乳酸曲线下面积为0.856 (P <0.001),95%CI:0.793～0.919,判断预后的最佳临界值为3.15 mmol/L,敏感度及特异度分别为71.4%和87.0%。结论需要机械通气、 APACHEⅡ评分高、低白蛋白血症及高乳酸血症与急诊重症监护室患者死亡密切相关;临床上应对患者这些指标足够重视,积极干预来改善预后。
Objective To analyze the risk factors of mortality among patients in emergency intensive care unit(EICU). Methods The information of patients who presented to the EICU of Shengjing Hospital of China Medical University from January 1,2017 to December31,2017 was collected and recorded. After three days of admission,the patients were divided into survival and death groups. Patients' gender,age,main diagnosis,medical history,hospitalization,treatment results,mechanical ventilation,APACHEⅡscore,and serum biochemical indicators were retrospectively analyzed. We used the t test,Chi-squared test,multiple binary logistic regression,and ROC curve to determine the mortality risk factors. Results Among 210 patients,161(76.7%) survived and 49(23.3%) died. Logistic regression analysis revealed that mechanical ventilation,high APACHEⅡscores,hypoalbuminemia,and hyperlactacidemia were independent significant influencing factors of mortality. ROC curve revealed that APACHEⅡscores,and serum albumin and lactic acid levels were able to predict the prognosis of EICU patients(P < 0.001). APACHEⅡscores and serum lactic acid levels were associated with higher sensitivity and specificity. Conclusion Mechanical ventilation,high APACHEⅡscores,hypoalbuminemia,and hyperlactacidemia are closely related to mortality of patients in EICU. The above indicators demand careful attention and active intervention to improve the prognosis of those patients.
Objective To analyze the risk factors of mortality among patients in emergency intensive care unit(EICU). Methods The information of patients who presented to the EICU of Shengjing Hospital of China Medical University from January 1,2017 to December31,2017 was collected and recorded. After three days of admission,the patients were divided into survival and death groups. Patients' gender,age,main diagnosis,medical history,hospitalization,treatment results,mechanical ventilation,APACHEⅡscore,and serum biochemical indicators were retrospectively analyzed. We used the t test,Chi-squared test,multiple binary logistic regression,and ROC curve to determine the mortality risk factors. Results Among 210 patients,161(76.7%) survived and 49(23.3%) died. Logistic regression analysis revealed that mechanical ventilation,high APACHEⅡscores,hypoalbuminemia,and hyperlactacidemia were independent significant influencing factors of mortality. ROC curve revealed that APACHEⅡscores,and serum albumin and lactic acid levels were able to predict the prognosis of EICU patients(P < 0.001). APACHEⅡscores and serum lactic acid levels were associated with higher sensitivity and specificity. Conclusion Mechanical ventilation,high APACHEⅡscores,hypoalbuminemia,and hyperlactacidemia are closely related to mortality of patients in EICU. The above indicators demand careful attention and active intervention to improve the prognosis of those patients.
引文
[1]ASLANER MA,AKKA M,ERO LU S,et al.Admissions of critically ill patients to the ED intensive care unit[J].Am J Emerg Med,2015,33(4):501-505.DOI:10.1016/j.ajem.2014.12.006.
[2]KNAUS WA,DRAPER EA,WAGNER DP,et al.APACHEⅡ:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.DOI:10.1097/00003246-198608000-00028.
[3]VILLAR J,LIGHTHALL G.Serum lactate level predicts 3-day,30-day,and 1-year mortality in patients with and without sepsis[J].Crit Care Med,2016,44(12):160.DOI:10.1097/01.ccm.0000509011.95248.
[4]何绍亚,向阳生,王岭,等.重症急性胰腺炎早期5因素体系与分级评分对患者死亡的评估价值研究[J].中国急救复苏与灾害医学杂志,2016,11(1):23-27.DOI:10.3969/j.issn.1673-6966.2016.01.008.
[5]董自平,刘创建,路桂杰.SCS评分在急诊老年危重患者中的应用价值[J].中国急救复苏与灾害医学杂志,2015,10(8):719-721.DOI:10.3969/j.issn.1006-1959.2015.28.201.
[6]KOLDITZ M,BAUER TT,K NIG T,et al.3-day mortality in hospitalised community-acquired pneumonia:frequency and risk factors[J].Eur Resp J,2016,47(5):1572-1574.DOI:10.1183/13993003.00113-2016.
[7]FURUKAWA M,KINOSHITA K,YAMAGUCHI J,et al.Sepsis patients with complication of hypoglycemia and hypoalbuminemia are an early and easy identification of high mortality risk[J].Int Emerg Med,2019:1-10.DOI:10.1007/s11739-019-02034-2.
[8]包磊,张敏,颜培夏,等.动脉血乳酸及其清除率预测感染性休克患者预后的回顾性研究[J].中华危重病急救医学,2015,27(1):38-42.DOI:10.3760/cma.j.issn.2095-4352.2015.01.009.
[9]JUNG YT,JEON J,PARK JY,et al.Addition of lactic acid levels improves the accuracy of quick sequential organ failure assessment in predicting mortality in surgical patients with complicated intra-abdominal infections:a retrospective study[J].World J Emerg Surg,2018,13(1):14.DOI:10.1186/s13017-018-0173-6.
[10]祝小梅,冯辉斌,邵碧波,等.血乳酸及乳酸清除率对感染性休克预后的预测价值[J].实用医学杂志,2012,28(23):3899-3901.DOI:10.3969/j.issn.1006-5725.2012.23.017.
[11]SHAHABI M,YOUSEFI H,YAZDANNIK AR,et al.The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation[J].Iran J Nurs Midwifery Res,2016,21(5):541-546.DOI:10.4103/1735-9066.193420.
[2]KNAUS WA,DRAPER EA,WAGNER DP,et al.APACHEⅡ:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.DOI:10.1097/00003246-198608000-00028.
[3]VILLAR J,LIGHTHALL G.Serum lactate level predicts 3-day,30-day,and 1-year mortality in patients with and without sepsis[J].Crit Care Med,2016,44(12):160.DOI:10.1097/01.ccm.0000509011.95248.
[4]何绍亚,向阳生,王岭,等.重症急性胰腺炎早期5因素体系与分级评分对患者死亡的评估价值研究[J].中国急救复苏与灾害医学杂志,2016,11(1):23-27.DOI:10.3969/j.issn.1673-6966.2016.01.008.
[5]董自平,刘创建,路桂杰.SCS评分在急诊老年危重患者中的应用价值[J].中国急救复苏与灾害医学杂志,2015,10(8):719-721.DOI:10.3969/j.issn.1006-1959.2015.28.201.
[6]KOLDITZ M,BAUER TT,K NIG T,et al.3-day mortality in hospitalised community-acquired pneumonia:frequency and risk factors[J].Eur Resp J,2016,47(5):1572-1574.DOI:10.1183/13993003.00113-2016.
[7]FURUKAWA M,KINOSHITA K,YAMAGUCHI J,et al.Sepsis patients with complication of hypoglycemia and hypoalbuminemia are an early and easy identification of high mortality risk[J].Int Emerg Med,2019:1-10.DOI:10.1007/s11739-019-02034-2.
[8]包磊,张敏,颜培夏,等.动脉血乳酸及其清除率预测感染性休克患者预后的回顾性研究[J].中华危重病急救医学,2015,27(1):38-42.DOI:10.3760/cma.j.issn.2095-4352.2015.01.009.
[9]JUNG YT,JEON J,PARK JY,et al.Addition of lactic acid levels improves the accuracy of quick sequential organ failure assessment in predicting mortality in surgical patients with complicated intra-abdominal infections:a retrospective study[J].World J Emerg Surg,2018,13(1):14.DOI:10.1186/s13017-018-0173-6.
[10]祝小梅,冯辉斌,邵碧波,等.血乳酸及乳酸清除率对感染性休克预后的预测价值[J].实用医学杂志,2012,28(23):3899-3901.DOI:10.3969/j.issn.1006-5725.2012.23.017.
[11]SHAHABI M,YOUSEFI H,YAZDANNIK AR,et al.The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation[J].Iran J Nurs Midwifery Res,2016,21(5):541-546.DOI:10.4103/1735-9066.193420.