ICU颅脑损伤患者发热与病死率相关性的研究

Correlation Research of Fever and Case Fatality Rate in Patients with Craniocerebral Injury in ICU

目的探讨ICU颅脑损伤患者发热发生的危险因素以及发热与病死率相关性。方法对入选的72例患者临床资料进行分析,脑损伤患者患者分别按性别、年龄(±2年)、以及疾病的严重程度(APACHE-域评分±5分)与非脑损伤患者进行匹配。入住ICU第一个24h内的最高温度高于37.5℃者确定为发热。主要转归指标为病死率。结果36例脑损伤患者年龄为65.5±14年,47豫为男性,平均APACHE-域评分为15(IQR11-20)。平均住院时间脑损伤患者明显低于非脑损伤患者。相较于非神经系统患者来说,脑损伤患者的平均最高温度更高,入住ICU后脑损伤患者发热更易出现。两组相比较脑损伤患者病死率高于非脑损伤患者(30%vs 20%,<0.05)。在单因素分析中,入ICU后发烧与病死率相关。在多因素分析中,APACHE-域,神经系统疾病,MAP,循环系统与呼吸系统功能衰竭,发热均与院内病死率相关。结论脑损伤后发热经常发生,且与院内病死率相关。

Objective To evaluate the predictors of fever with in patients,and to study the ef ect of fever on in-hospital case fatality.Methods Retrospective data col ection of consecutive patients admit ed to the intensive care unit(ICU).Neurological patients were matched by sex,age,and Acute Physiology and Chronic Health Evaluation II(APACHE-II)to a cohort of nonneurological patients.Fever was defined as any temperature>37.5℃within the first 24 hours upon admission to the ICU.The primary outcome measure was in-hospital case fatality.Results Mean age among neurological patients was 65.5±14 years,47%were men,and median APACHE-II was 15(interquartile range 11-20).More neurological patients experienced fever than nonneurological patients.The mean hospital length of stay was higher for nonneurological patients,and more neurological patients were dead at hospital discharge(30%vs 20%,<0.05).The fol owing variables were associated with higher in-hospital case fatality:APACHE-II,neurological diagnosis,mean arterial pressure,cardiovascular and respiratory dysfunction in ICU,and fever.Conclusion These data suggest that fever is a frequent occurrence after brain injury,and that it is associated with in-hospital case fatality.