危急病患者急性功能衰竭:一项跨国多中心研究
Shigehiko Uchino1, John A Kellum, Rinaldo Bellomo
1Department of Intensive Care, Austin Hospital, Melbourne, Australia.
JAMA
|August 18, 2005
概括
急性功能衰竭 (ARF) 影响全球5-6%的重症监护病房患者,败血症休克是主要原因. 这种危急状况与高的医院死亡率有关,强调需要改进管理策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 流行病学 流行病学
背景情况:
- 急性功能衰竭 (ARF) 是严重疾病的一个重大问题,但其全球流行病学和结果仍然不太清楚.
- 现有的知识差距凸显了对ARF患病率和相关死亡率的全面国际数据的需求.
研究的目的:
- 为了确定在多个国家的重症监护室 (ICU) 患者中ARF的周期流行率.
- 在全球范围内分析ARF病因,疾病严重程度和临床实践的变异.
- 评估这些多样化因素对患者结果和死亡率的影响.
主要方法:
- 一项前性,跨国观察性研究,涉及23个国家的54家医院.
- 从2000年9月到2001年12月收集的关于符合ARF标准或接受脏替代疗法 (RRT) 的ICU患者的数据.
- 关键结果措施包括ARF发生,病因,严重程度,治疗,出院后的支持和医院死亡率.
主要成果:
- 在ICU患者中,ARF的周期流行率为5.7%,其中1260名患者需要RRT.
- 败血性休克是最常见的ARF (47.5%) 的原因,30%的患者先前存在功能障碍.
- 总体上,住院死亡率为60.3%,其中13.8%的幸存者在出院时依赖透析. 独立的死亡预测因素包括血管压缩剂的使用,机械通风,败血症休克,心脏性休克和肝综合征.
结论:
- 该研究证实,在全球范围内,在ICU中需要RRT的ARF的周期流行率为5-6%.
- 重症患者的ARF与实质性的医院死亡率有关.
- 多因素风险因素显著影响ICU患者ARF的死亡率.
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