重症监护病房急诊抢救危重病患者的死亡危险因素分析

摘要

Objective To explore the risk factors of death for critically ill patients during emergency treatment in intensive care unit, and to provide the consults for critically ill patients during emergency treatment. Methods Sixty - eight critically ill patients were included during 2008 and 2011 in the emergency department of hospital. The general conditions of each case were recorded and acute physiology and chronic health evaluation II ( APACHE II ) of each case were calculated. Levels of brain natriuretic peptide ( BNP ) and cTnT cardiac troponin ( Ct - Ni ) of each case were determined, and survival informations were followed. Cases were divided into survival group and death group according to the survival conditions on 28th day. Age, gender, levels of BNP and Ct - Ni, and APACHE II in both groups were statistically analyzed. Results There were respectively 43 cases ( 63. 2% ) in survival group and 25 cases ( 36. 8% ) in death group. The results of single factor analysis indicated that age,levels of BNP and Ct - Ni, and APACHE II were statistically different in both groups ( P < 0. 01 ) except gender ( P >0. 05 ). The results of multi - factor analysis indicated that age, levels of BNP and Ct - Ni, and APACHE II were the risk factors of death for critically ill patients. Conclusion Age,levels of BNP and Ct - Ni, and APACHE II are the risk factors of death for critically ill patients, and they have the guiding significance to clinical prognosis for critically ill patients during emergency treatment.%目的 探讨影响重症监护病房急诊抢救危重患者的死亡危险因素,为急诊抢救危重患者提供参考依据.方法 2008年1月-2011年12月危重病患者68例纳入本次研究.记录患者基本情况,计算每位患者的急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ).测定患者血液中脑利钠肽(brain natriuretic peptide,BNP)和心肌肌钙蛋白(cTnT cardiac troponin,cT-nI)水平,随访患者28d的生存情况.根据28d患者存活情况将患者分为存活组和死亡组.对2组患者年龄、性别、血液BNP和cT-nI水平以及APACHEⅡ评分进行统计分析.结果 28d时存活组和死亡组患者分别为43例(63.2%)和25例(36.8%).死亡组和存活组的性别组间差异无统计学意义(P＞0.05),而年龄、血液BNP和cT-nI水平以及APACHEⅡ评分组间差异均有统计学意义(P＜0.01).多因素分析结果显示,年龄、血液BNP和cT-nI水平以及APACHEⅡ评分均为影响急诊重症患者死亡的危险因素.结论 年龄、血液BNP和cT-nI 以及APACHEⅡ评分为影响急诊重症患者死亡的危险因素,对于判断急诊重症患者的临床预后具有一定的指导意义.