入重症监护室治疗对食管癌患者术后并发症的影响

Influences of Admission to Intensive Care Unit on the Postoperative Complications in Patients with Esophageal Carcinoma

目的：探讨食管癌术后入重症监护室（intensive care unit,ICU）治疗对患者术后并发症的影响。方法：选择2009年1月—12月在复旦大学附属中山医院胸外科确诊并经手术治疗的391例食管癌患者,均有详细的临床资料及术后随访资料。将患者分为术后入ICU组（治疗组）和术后入普通病房组（对照组）。按有否发生术后非计划性入ICU,将对照组分为对照组A（未非计划性入住ICU）和对照组B（非计划性入住ICU）。比较3组患者术后并发症的发生率的差异。术后并发症采用Logistic多因素回归分析。结果：治疗组患者术后当天的APACHEⅡ评分高于对照组A（P〈0.05）,但前者术后并发症发生率相对于后者并未增加;对照组A APACHEⅡ评分低于对照组B（P〈0.05）,对照组A术后并发症发生率明显低于对照组B（P〈0.01）;治疗组APACHEⅡ评分高于对照组B（P〈0.05）,但治疗组术后并发症发生率低于对照组B（P〈0.01）。Logistic回归分析结果表明,术后当天的急性生理与慢性健康评分Ⅱ（acute physiology and chronic health evaluation,APACHEⅡ）评分越高,术后并发症发生率越高[风险比（HR）=0.631,95%可信区间（95%CI）：0.405～0.983,P〈0.05）。术后直接入ICU治疗能降低术后并发症的发生,是其独立相关因素（HR=1.588,95%CI：1.147～2.199,P〈0.01）。结论：食管癌术后及时入ICU进行综合治疗能降低患者并发症的发生率。

Objective：To investigate the influence of admission to intensive care unit（ICU）on the postoperative complications in patients with esophageal carcinoma.Methods：A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery,Zhongshan Hospital,Fudan University,from Jan 2009 to Dec 2009,were chosen.All the patients had clinical data and postoperative follow-up data in detail.Patients were divided into postoperative ICU group（treatment group）and postoperative general ward group（control group）.The control group was further classified into control group A（without unplanned ICU admission）and control group B（with unplanned ICU admission）based on whether unplanned admission to ICU was conducted.The occurrence rates of postoperative complications were compared among the three groups.Logistic regression was performed in multivariate analysis of postoperative complications.Results：On Day 1 after surgery,the APACHE Ⅱ score was higher in treatment group than in control group I（P〈0.05）.However,there was no increase on rate of postoperative complications in treatment group.The APACHE Ⅱ score,as well as the occurrence rate of postoperative complications,was lower in control group A than those in control group B（P〈0.01）.The APACHE Ⅱ score in treatment group was higher than that in control group B（P〈0.05）.However,the occurrence rate of postoperative complications in treatment group was lower than that in control group B（P〈0.01）.On Day 1 after surgery,the higher the postoperative acute physiology and chronic health evaluation（APACHE）Ⅱscore was,the higher the occurrence rate of postoperative complications was（HR=0.631,95% CI：0.405～0.983,P〈0.05）.Postoperative planned ICU admission could diminish postoperative complications,and it was the independent factor（HR=1.588,95% CI：1.147-2.199,P〈0.01）.Conclusions：If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation,the occurrence rate of complications could be reduced in esophageal cancer patients.