3 321例ICU重症患者急性胃肠功能障碍的发生及其预后

Incidence and prognosis of critical patients with acute gastrointestinal dysfunction in ICU： a report of 3 321 cases

目的 总结重症医学科（ICU）重症患者急性胃肠功能障碍的发生及其预后。方法 选取2008年1月—2012年12月收住蚌埠医学院第一附属医院重症医学科的重症患者3 321例为研究对象,观察其急性胃肠损伤（AGI）的发生率;根据AGI严重程度分为AGI Ⅰ～Ⅳ组,观察比较4组重症患者的年龄、性别、急性生理学与慢性健康评估（APACHE）Ⅱ评分等一般指标,以及ICU留治时间和病死率。结果 本组3 321例中,并发AGI者2 261例,发病率68.08%,其中AGI Ⅰ级～Ⅳ级例数依次为1 123例（33.81%）、586例（17.65%）、367例（11.05%）、185例（5.57%）。男/女比例、年龄在AGI Ⅰ～Ⅳ级4组患者间比较,差异无统计学意义（P值均〉0.05）;而APACHEⅡ评分、ICU留治时间在4组间比较,差异有统计学意义（P值均〈0.01）。在纳入研究3 321例重症患者中,病死率为4.73%（157/3 321）;其中AGI Ⅰ～Ⅳ级病死率依次为2.76%（31/1 123）、6.31%（37/586）、9.81%（36/367）、28.65%（53/185）,4组间比较,差异有统计学意义（χ2=170.316,P=0.000）。结论 重症患者的急性胃肠功能障碍发生率高,严重影响患者预后。

Objective To explore the incidence and prognosis of critical patients with acute gastrointestinal dysfunction in ICU. Methods Critical patients in intensive care unit（ICU）of the First Affiliated Hospital of Bengbu Medical College admitted from January 2008 to December 2012 were studied retrospectively. The incidence of acute gastrointestinal injury （AGI） was observed. According to the AGI degree of concurrency, the patients were divided into four groups （AGI Ⅰ-Ⅳ group）. Clinical index in four groups as age, gender （male/female）, APACHE Ⅱ score and the length of ICU stay, mortality were analyzed. Results A total of 3 321 patients were collected, 2 261 of them suffered from AGI. The morbidity was 68.08％, including AGI grade Ⅰ 1 123 cases（33.81％）, grade Ⅱ 586 cases（17.65％）, grade Ⅲ 367 cases（11.05％）, grade Ⅳ 185 cases（5.57%）. There were no significant differences in the male / female ratio and the age among the four groups（all P values〉0.05）, but significant differences in the APACHE Ⅱ score and the length of ICU stay （all P values〈0.01）. In the 3 321 cases of severe patients, the mortality rate was 4.73% （157/3 321）, and the mortality of AGI Ⅰ-Ⅳ group was 2.76% （31/1 123）, 6.31% （37/586）, 9.81% （36/367）, 28.65% （53/185）, there were significant differences in the mortality among the four groups （χ2=170.316, P=0.000）. Conclusions The incidence of critical patients with acute gastrointestinal dysfunction is high, and seriously affects the prognosis.