呼吸重症患者非计划重返ICU的发生现状及危险因素分析

Analysis on incidence and risk factors for unplanned ICU readmission in critical patients with severe respiratory diseases

目的分析呼吸重症患者非计划重返ICU的现状和危险因素。方法回顾性分析2018~2020年期间入住四川大学华西医院呼吸与危重症医学科的患者资料,采用自行设计的收集表进行资料收集,采用单因素分析和Logistic回归分析呼吸重症患者非计划重返ICU的影响因素。结果共纳入459例患者资料,呼吸重症患者24 h、48 h、72 h、7 d内、7 d以上非计划重返ICU发生率分别为2%、4.1%、5.2%、8.7%、14.4%。单因素分析结果显示:年龄、APACHE-Ⅱ评分、首次ICU住院天数、转出时GCS评分、慢性心血管疾病史、慢性呼吸系统疾病史、慢性肾病史、合并脑卒中、合并糖尿病、转出后发生谵妄、发生误吸、咳痰无力、痰液较多、转出时携带气管切开导管、转出时呼吸支持方式、停止有创机械通气至转出之间时间间隔等因素,与呼吸重症患者的非计划重返ICU相关(P<0.05)。Logistic回归结果示APACHE-Ⅱ评分(OR=1.071)、转出后发生误吸(OR=20.380)、咳痰无力(OR=27.931)、痰液较多(OR=7.469)是非计划重返ICU发生的独立危险因素。结论呼吸重症患者非计划重返ICU发生率较高,APACHE-Ⅱ评分高、转出后发生误吸、咳痰无力、痰液较多是其重返ICU的危险因素,可考虑从预防误吸、加强呼吸康复、改善咳痰能力等角度加以改善。

Objective To analyze the incidence and risk factors for unplanned ICU readmission of critical patients with severe respiratory diseases.Methods The data of patients admitted to the Department of Respiratory and Critical Care Medicine of West China Hospital of Sichuan University from 2018 to 2020 were collected retrospectively through a self-designed form.The influencing factors of unplanned ICU readmission of critical patients with severe respiratory diseases were analyzed by univariate analysis and Logistic regression.Results A total of 459 patients were enrolled in the study.The incidence of unplanned ICU readmission of critical patients with severe respiratory diseases within 24 hours,48 hours,72 hours,7 days and more than 7 days was 2%,4.1%,5.2%,8.7%and 14.4%respectively.The results of univariate analysis showed that factors such as age,APACHE-Ⅱscore,length of first ICU stay,GCS score at transfer,history of chronic cardiovascular disease,history of chronic respiratory disease,history of chronic kidney disease,combined stroke,combined diabetes,delirium after transfer,occurrence of aspiration,weakness of expectoration,excessive sputum,carrying a tracheotomy catheter at transfer,mode of respiratory support at transfer,and time interval between cessation of invasive mechanical ventilation and transfer were associated with unplanned ICU readmission of critical patients with severe respiratory diseases(P<0.05).Logistic regression results showed that APACHE-II score(OR=1.071),occurrence of aspiration after transfer(OR=20.380),weakness of expectoration(OR=27.931)and excessive sputum(OR=7.469)were independent risk factors for occurrence of unplanned ICU readmission.Conclusion The incidence of unplanned ICU readmission of critical patients with severe respiratory diseases is high.High APACHE-Ⅱscore,occurrence of aspiration after transfer,weakness of expectoration and excessive sputum are risk factors od readmission.It can be improved by preventing aspiration,strengthening respiratory rehabilitation and improving expectoration ability.