贵州省地州市县二级及以上公立医院重症医学科近3年运行状况及老年危重症患者的分布——2018至2020年144个ICU的回顾性分析

Analysis on the operation status of department of critical care medicine and the distribution of critically ill elderly patients of second-level and above public hospitals in prefectures and counties of Guizhou Province in the past three years:a retrospective study of 144 intensive care units from 2018 to 2020

目的分析贵州省地州市县二级及以上公立医院重症医学科近3年运行状况及老年危重症患者来源科室、手术及并发症的分布占比情况,为了解老年危重症患者的流行病学的特征和提高诊疗救治水平提供临床依据。方法依托“2021贵州省重症医学质控行动”采用现场调查的方法,收集2018年1月1日至2020年12月31日贵州省地州市县二级及以上公立医院综合重症监护病房(ICU)患者的总收治人数,≥65岁老年患者收治数、非手术人数、手术人数、不同手术部位(头部、胸部、腹部、四肢)患者数,老年患者并发症〔休克、昏迷、脓毒症、急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)、急性肾损伤(AKI)、肝功能异常、凝血功能异常〕情况,并进行分布占比数据分析。结果共采集到147个ICU的165224例患者资料,排除2020年后建科的3个ICU及年龄信息缺失的8714例患者后,实际纳入144个ICU 156510例患者,其中≥65岁老年患者68480例(2018年19054例,2019年23918例,2020年25508例),占比43.75%。与2018年比较,2019年老年患者收治定基比增长速度为25.53%,2020年定基比增长速度33.87%,老年患者收治年平均增长速度为15.70%。老年患者手术组纳入18437例,手术率为29.01%(18437/63557),排名前2位的手术部位为腹部手术(8904例,占48.29%)和头部手术(5234例,占28.39%)。老年患者并发症组纳入59671例,并发症总数64500个(占108.09%),前3位为昏迷(13286例,占22.27%)、脓毒症(12415例,占20.81%)和休克(11773例,占19.73%),排后3位的为MODS(5251例,占8.80%)、ARDS(4098例,占6.87%)和急性肾衰竭(4061例,占6.81%)。结论贵州省地州市县二级及以上公立医院144个ICU的老年危重症患者收治占比较大且呈明显上升趋势,手术部位以腹部和头部为主,排名前3的合并症为昏迷、脓毒症和休克。

Objective To analyze the operation status of intensive care units of second-level and above public hospitals in the counties of Guizhou Province of the past three years,and the distribution and proportion of the departments,surgeries and complications of critically ill elderly patients,so as to provide clinical basis for understanding the epidemiological characteristics of critically ill elderly patients and improving the level of diagnosis and treatment.Methods Patients admitted to the comprehensive intensive care unit(ICU)of the second-level and above public hospitals in counties of Guizhou Province from January 1,2018 to December 31,2020 was enrolled by on-site investigation,based on the"2021 Guizhou Province Critical Care Medicine Quality Control Action".The distribution and proportion of elderly patients who were older than 65 years were analyzed for the number of admitted patients,non-surgical patients,surgical patients,surgical sites(head,chest,abdomen,limbs),and complications[shock,coma,sepsis,acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS),acute kidney injury(AKI),abnormal liver function,abnormal coagulation function].Results A total of 165224 patients in 147 ICUs were enrolled.After excluding 3 ICUs established after 2020 and 8714 patients without age information,156510 patients in 144 ICUs were actually included,and there were 68480 patients older than 65 years(19054 in 2018,23918 in 2019,and 25508 in 2020),accounting for 43.75%.Compared with 2018,the growth rate of the fixed-base ratio of elderly ICU patients in 2019 was 25.53%,and the growth rate of fixed-base ratio in 2020 was 33.87%.The average annual growth rate of elderly ICU patients was 15.70%.There were 18437 elderly patients received operation,and the operation rate was 29.01%(18437/63557),and the top 2 surgical sites were abdominal(8904 cases,accounting for 48.29%)and head(5234 cases,accounting for 28.39%).There were 59671 elderly patients underwent complication,the total number of complications was 64500(108.09%),the top 3 were coma(13286 cases,accounting for 22.27%),sepsis(12415 cases,accounting for 20.81%)and shock(11773 cases,accounting for 19.73%),and the last three were MODS(5251 cases,accounting for 8.80%),ARDS(4098 cases,accounting for 6.87%)and AKI(4061 cases,accounting for 6.81%).Conclusions The proportion of critically ill elderly patients admitted to 144 ICUs of second-level and above public hospitals in counties of Guizhou Province was relatively large and showed a significant upward trend.The main surgical sites were abdomen and head,and the top 3 complications were coma,sepsis and shock.