早期干预对转入ICU肿瘤重症患者预后的影响

Effect of early intervention on prognosis of ICU patients with severe tumor

目的 评价在普通病房住院期间发生生理紊乱并最终转入ICU的肿瘤重症患者进行早期干预对患者预后的影响。方法 在我院肿瘤科建立院内急救小组（MET），制定MET启动标准，对发生生理紊乱并最终入住ICU的重症患者进行早期干预，根据患者是否院内死亡，将患者分为存活组与死亡组。根据对患者干预时机不同，将患者分为前期干预组与后期干预组。比较早期干预、早期干预时机对各组患者预后的影响，采用Cox比例风险模型评价影响患者预后的独立因素。结果 共有449例肿瘤重症患者经过MET急救并从普通病房转入ICU。其中145例（32.3%）患者在入住ICU期间死亡，死亡组的干预时间显著高于存活组［（2.98±0.82）h vs. （1.32±0.47）h，t=21.095，P＜0.001］。前期干预组的ICU病死率［18.0% （34/189）vs. 42.3%（110/260）， χ2=29.709，P＜0.001］、住院病死率［39.7%（75/189） vs. 67.7%（176/260）， χ2=34.831，P＜0.001］、30 d病死率［29.1%（55/189） vs. 55.0%（143/260）， χ2=29.780，P＜0.001］与1年病死率（log-ank test，P=0.029）显著低于后期干预组。Cox比例风险模型分析表明，干预时间与患者1年病死率呈正相关（HR=1.027，95%CI 1.017～1.037，P＜0.001）。早期干预（HR=0.456，95%CI 0.348～0.597，P＜0.001）、前期干预（HR=0.485，95%CI 0.372～0.633，P＜0.001）与患者1年病死率呈负相关。结论 对普通病房住院恶性肿瘤患者的临床紊乱进行早期干预，可以显著改善患者的短期与长期预后，因此，对其进行早期识别和及时救治具有重要意义。

Objective To evaluate the effect of early interventionon the prognosis of patients with severe tumor in the general wards during hospitalization and eventually transferred to ICU. Methods The medical emergency team （MET） was established in the oneology department of our hospital. MET startup standards were draught up. Early intervention for patients with severe tumor with physiological disturbances and eventually admitted to ICU. The patients were divided into survival group and death group according to whether the patient died in hospital; and divided into pre - intervention group and post- intervention group according to different timing of patient intervention. The effect of early intervention and early intervention time on the prognosis of each group was compared. Cox proportional hazards model was used to evaluate the independent factors affecting the prognosis of patients. Results A total of 449 patients with severe tumor were treated with MET and transferred from general ward to ICU. 145 （32.3%） patients died during their stay in ICU. The intervention time （t =21. 095, P 〈 0. 001 ） of the death group was significantly higher than that of the survival group [ （2.98 ±0.82） h vs. （1.32±0.47）h, t =21.095, P〈0. 001]. The ICU mortality[18.0% （34/189）vs. 42.3%（110/260）, x2 = 29. 709, P 〈 0.001 ], hospital mortality [ 39.7 % （75/189） vs. 67.7 % （ 176/260 ）, X2 = 34.831, P 〈0. 001 ], 30 - day mortality[29.1% （55/189） vs. 55.0% （ 143/260）, X2 =29. 780, P 〈 0.001 ] ,and 1 year cumulative mortality （ log - rank test, P = 0. 029 ） in the pre - intervention group were significantly lower than those in the post - intervention group. Cox proportional hazard model analysis showed that the intervention time （ HR = 1. 027, 95% CI 1. 017 - 1. 037, P 〈 0. 001 ） was positively correlated with the 1 year mortality rate. Early intervention（ HR = 0. 456, 95% CI 0. 348 - 0.597, P 〈 0. 001 ） and early intervention in earlier stage （ HR = 0. 485, 95% CI 0. 372 - 0. 633, P 〈 0.001 ） were negatively correlated with 1 year mortality rate. Conclusion Early intervention can significantly improve the short - term and long - term prognosis of patients with severe tumor in the general ward. Therefore, early identification and timely treatment are of great significance.