影响危重病患者预后的相关因素分析

Study on the relatively risk factors influenced the prognosis for critically-ill patients

目的探讨影响危重病患者预后的相关因素。方法回顾性分析2010年1月～2011年8月98例我院ICU治疗的危重病患者的临床资料。结果 98例危重病患者死亡36例,死亡率为36.73%。影响患者预后的相关因素较多,住院时间、MAP、pH值、Ca2+水平、APACHE-II评分、ALT、CRP、Cr、BUN、乳酸、CO2分压、H2S水平、平均动脉压、心率、术中并发症发生率、有创诊疗项目及机械通气时间等均为可能的影响因素(P<0.05)。多因素回归分析结果显示,住院时间、乳酸、APACHE-II评分、Ca2+水平、有创诊疗项目以及机械通气时间是影响预后的独立因素(P<0.05),其中住院时间的保护性因素,其余是死亡危险因素。结论影响危重病患者预后的因素众多,可将住院时间、乳酸、APACHE-II评分、Ca2+水平、有创诊疗项目以及机械通气时间作为评估患者预后的重要指标,根据多种指标的结果及患者病情采取积极的抢救措施,以降低患者病死率。

Objective To investigate relatively risk factors influenced the prognosis for critically-ill patients. Methods The clinical data of 98 critically-ill patients were analyzed. Results Themortality rate was 36.73%. There were many relatively risk factors may influence the prognosis for critically-ill patients, such as ICU stay, mean arterial pressure, acute physiology and chronic health evaluation （APACHE-Ⅱ）, PH value, carbon dioxide partial pressure, Ca^（2＋）, alanine aminotransferase, aspartate aminotrasferse, lactate, C-reactive protein, creatine, uric acid nitrogen, hydrogen sulfide, hypocalcemia incidence, invasive treatment and time of mechanical ventilation （P 〈 0.05）. The logistic regression analysis showed that ICU stay, APACHE-II, Ca2＋, lactic acid, invasive treatment and the time of mechanical ventilation were independent factors influencing prognoses of critically-ill patients. Conclusion There are many relatively risk factors may influence the Prognosis for critically-ill patients, ICU stay, APACHE-Ⅱ, Ca^（2＋）, lactic acid, invasive treatment and the time of mechanical ventilation could be used as reference indexes for critically-ill patients, we should take an active rescue measures according to the results of a variety of indicators and the patient＇s condition, in order to reduce mortality rate of critically-ill patients.