综合医院危重症患者1735例死亡危险因素分析

Risk factors for death among critically ill patients in comprehensive hospitals: analysis of 1735 cases

摘要:

目的 探讨综合医院危重症患者死亡的危险因素, 以提高诊治质量。方法 回顾性分析2005年至2010年重症监护病房收治的1735例患者, 其中198例于重症监护病房（ICU）死亡, 135例出ICU后死亡, 对198例患者各年龄段进行统计学分析, 并调查疾病分布特点; 对比ICU内、外器官功能衰竭数与死亡率, 检验各种危险因素对死亡的影响。结果 老年组死亡率明显高于非老年组, 差异有统计学意义（P＜0.01）。随年龄增长, 死亡率呈增高趋势; 发生功能障碍器官数与死亡率密切相关, 功能障碍器官数越多, 死亡率越高; 当有5个或5个以上器官发生功能障碍时, 死亡率接近100%。当衰竭器官数≤3个时, ICU内死亡率明显低于ICU外死亡率（P＜0.01）。从器官功能障碍分布来看, 心血管系统功能障碍发生率高达51.8%, 死亡率却低; 致死性最高的功能障碍器官是: 血液（59.3%）、肾（58.7%）; ICU内、外致死的障碍功能器官不同。结论 降低危重症患者死亡率首先要降低≥60岁老年人的死亡率, 明确原发病和受损器官, 积极控制疾病向多器官功能衰竭的发展, 保护重要脏器功能在危重症患者治疗中占重要地位。

Abstract:

Objective To explore risk factors for death among critically ill patients in comprehensive hospitals so as to improve the diagnosis and treatment level for these patients. Methods Data of 1735 patients who were admitted to intensive care unit (ICU) during the period of 2005 to 2010 were retrospectively analyzed. Among these patients, there was 198 ICU death and 135 post-ICU death. The characteristics of disease distribution were investigated in different age groups (＜60, 60-80, ≥60 years) among 198 ICU death patients. The death rate and number of organ failure were compared between ICU death and post-ICU death patients. The risk factors for death were analyzed. Results The death rate was significantly higher in elderly group than in non-elderly group, with difference between the two groups (P＜0.01). The death rate displayed an elevating tendency with age increase. Number of organ failure was positively correlated with death rate, which was almost up to 100% when there were more than five organ failures.When organ failure number was less than three, the ICU death rate was significantly less than post-ICU death rate (P＜0.01). According to the distribution of organ dysfunction, the incidence of cardiovascular dysfunction was the highest (51.8%), but with lower death rate. The death rate was comparatively higher in patients with blood system and renal dysfunction (59.3% and 58.7% respectively). The failure organ was different between ICU death and post-ICU death. Conclusion The reduction of death rate in elderly patients ≥60 years is fundamental for reduction of death rate of critically ill patients. To define the original disease and dysfunction organs, to actively control disease development into multiple organ dysfunction syndrome, and to protect main organ functions play important roles in the treatment of critically ill patients.