摘要
目的 探讨老年重症肺炎患者重返ICU原因及其预后影响因素分析.方法 选择2020年1月至2023年4月收治的300例老年重症肺炎,所有患者首次ICU治疗后病情均好转并转至普通病房治疗,其中有19例患者因病情加重重返ICU,其余281例患者未重返ICU.观察2组患者年龄、性别比、输血、急性生理学及慢性健康状况评分系统-Ⅱ(APACHE Ⅱ)评分、ICU监护时间、合并症、转出后发生误吸、转出后发生谵妄及咳嗽无力等临床情况,以分析患者重返ICU的影响因素.统计重返ICU患者预后情况,对比死亡患者与生存患者临床资料,分析其预后影响因素.结果 重返ICU及未重返ICU患者输血、ICU监护时间、转出前APACHE Ⅱ评分、合并糖尿病、转出后发生误吸及谵妄情况比较,差异有统计学意义(P＜0.05);多因素Logistic回归分析显示,老年重症肺炎患者重返ICU的独立危险因素为:转出前APACHE Ⅱ评分、ICU监护时间、合并糖尿病、转出后发生误吸、转出后发生谵妄(P＜0.05);死亡患者与生存患者重返ICU时APACHE Ⅱ评分、总ICU监护时间、合并糖尿病、转出后发生误吸及转出后发生谵妄情况比较,差异有统计学意义(P＜0.05);多因素Logistic回归分析显示,影响老年重症肺炎重返ICU患者预后的独立危险因素为:重返ICU时APACHE Ⅱ评分、总ICU监护时间、合并糖尿病、转出后发生误吸及谵妄(P＜0.05).结论 老年重症肺炎患者重返ICU原因及重返ICU患者预后的影响因素复杂,临床上需高度重视对高APACHE Ⅱ评分、ICU监护时间长、合并糖尿病、转出后发生误吸、谵妄患者的治疗和干预,尽可能减少重返ICU现象,并改善重返ICU患者预后.
Abstract
Objective To explore the reasons for elderly patients with severe pneumonia returning to intensive care unit(ICU)and to analyze the prognostic factors.Methods A total of 300 elderly patients with severe pneumonia admitted from January 2020 to April 2023 were selected.All patients had improved conditions after the initial ICU treatment and they were transferred to the general ward for further treatment.Among them,19 patients returned to the ICU due to worsening conditions,while the remaining 281 patients did not return to the ICU.Clinical conditions,including age,gender ratio,blood transfusion,the Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ score,length in ICU,comorbidities,aspiration after transferring to wards,delirium and cough weakness after transferring to wards were compared between groups.Influencing factors of elderly patients returning to ICU were analyzed.Prognosis of elderly patients returning to the ICU was observed.Clinical data of death cases and survivors were compared and the prognostic factors were explored.Results There were significant differences in blood transfusion,length in ICU,APACHE Ⅱ score before transferring to wards,complication of diabetes,aspiration and delirium after transferring to wards between patients who returned to ICU and those who did not return to ICU(P＜0.05).Multivariate logistic regression analysis showed that the independent risk factors of elderly patients with severe pneumonia returning to ICU were APACHE Ⅱ score before transferring to wards,length in ICU,diabetes,aspiration after transferring to wards,and delirium after transferring to wards(P＜0.05).There were significant differences in APACHE Ⅱ score,length in ICU,diabetes,aspiration after transferring to wards,and delirium after transferring to wards between dead cases and survivors returning to ICU(P＜0.05).Multivariate logistic regression analysis showed that the independent risk factors influencing the prognosis of elderly patients with severe pneumonia returning to ICU were APACHE Ⅱscore,length in ICU,diabetes,aspiration and delirium after transferring to wards(P＜0.05).Conclusion The reasons for the elderly patients with severe pneumonia returning to the ICU and the factors affecting the prognosis of the patients returning to the ICU are complex.Clinically,it is necessary to attach a great importance to the treatment and intervention of patients with high APACHE Ⅱ score,long length in ICU,diabetes,aspiration and delirium after transferring to wards,so as to reduce the incidence of returning to the ICU as much as possible and improve the prognosis of patients returning to the ICU.
NETL
NSTL
维普
万方数据