本院重症医学科患者疾病构成及预后分析

Disease constitution and prognosis of ICU patients

目的:探讨重症医学科患者的来源及疾病构成特点、预后分析,进而为临床诊治提供指导。方法:回顾分析本院2009年4月至2014年3月429例入住重症医学科患者的临床资料,分别收集性别、年龄段、病人来源、疾病构成及死亡组的主要疾病、APACHEⅡ评分等信息。结果:年龄≥65岁的老年患者占同期重症医学科住院患者的73.9%(317例)。老年患者入院APACHEⅡ评分较年轻组显著增高(P<0.01)。本组患者中男性多于女性,男248例,女181例,男女比例1.37∶1。其中来源于本院内科病房224例,急诊136例,外科术后60例,其他来源9例。位居疾病构成前三位的是脓毒症(215例)、脑卒中(71例)和心血管疾病(67例)。患者转归以转回普通病房最多,为213例(49.6%),出院者148例(34.4%),死亡68例(15.8%)。死亡患者APACHEⅡ评分较存活组显著增高(P<0.01),第一位死因为脓毒症(39例)。结论:本院重症医学科患者以老年为主,男性较多,绝大部分来源于内科病房,脓毒症是首位死因,APACHEⅡ评分与预后相关。

Objective： To explore the source of cases,the admission reasons and the therapy effect in intensive care unit（ ICU）. Methods： Retrospective analyses were performed on critically ill patients who were hospitalized in the ICU with age,sex and APACHE Ⅱ scores. 429 cases were selected and their spectrum of disease were analysed. Results： Older patients accounted for 73. 9% of the ICU hospitalized patients,the APACHE Ⅱ score of old group was significantly higher than that of younger ages（ P〈0. 01）. It consisted of 248 men and 181 women,the ratio of men to women was 1. 37 ∶ 1. The source of cases included： 224 cases（ 52. 5%） in group transferred from medical ward,136 cases（ 31. 6%） in group transferred from emergency,and 60 cases（ 13. 9%） from postoperation. According to their admission reasons,the proportion ratio in order respectively was sepsis（ 50. 1%）,stroke（ 16. 5%）,cardiovascular disease（ 15. 6%）. The outcome included： back to the general ward（ 49. 6%）,discharge（ 34. 4%）,death（ 15. 8%）. The APACHE Ⅱ score of death group was significantly higher than that of the survival group（ P〈0. 01）. The first cause of death was sepsis（ 39 cases）. Conclusion： In our ICU,the source of cases is mainly from medical ward,sepsis is the leading cause of death. APACHE Ⅱ score could predict prognosis in ICU patients.