再入重症监护室患者的预后多因素分析研究

Multivariate analyses for the outcome of critical ill patients with ICU readmission

目的明确重症患者再入ICU后的预后及与之相关的临床因素。方法收集2009年1月14日至2011年12月29日，收入复旦大学附属中山医院ICU进行治疗的2459例患者作为研究对象。所有患者按是否再入ICU分为未再入组（A组）和再入组（B）。所有治疗都按照复旦大学附属中山医院重症医学科的诊疗常规及相关临床指南，在专职ICU主治医师的参与下进行。结果再入ICU延长了患者的住院天数和住ICU时间，也是患者ICU病死率升高的独立预后因素（HR=2．246，95％CI 1．27-3．973，P=0．005）。进一步以再入ICU患者为研究对象，发现与再入ICU患者ICU病死率升高密切相关的因素包括首次入ICU时的APACHE Ⅱ评分≥16以及非外科患者。结论再入ICU是重症患者不良预后的相关因素。而造成再入ICU患者ICU病死率较高的主要原因是与患者首次入ICU的基础情况密切相关，包括疾病严重程度和是否手术患者。

Objective To investigate the outcome of the critical ill patients readmitted to ICU and factors from the first ICU admission impacting on the outcome of patients after ICU readmission. Method A total of 2 459 patients admitted to ICU from 14th, Jan, 2009 to 29th, Dec, 2011 were enrolled for study. Patients were classified into non-readmission group （A） and readmission group （B）. According to our ICU routine and clinical guideline, attending intensivists were responsible for all the ICU treatment. Results ICU readmission was not only related to prolonged hospital stay or ICU stay, but also independently associated with a lower ICU survival rate [ HR = 2. 246, 95% CI 1. 27-3. 973, P = 0. 005 ]. In the further analyses of Group B, that high APACHE Ⅱscore was found at the first admission and non-surgical patients were independently related to higher ICU mortality. Conclusion ICU readmission was associated with low ICU survival rate. The influence of ICU readmission on ICU outcome was affected by clinical factors at the first ICU admission, including APACHE II score and surgery.