在接受重症监护的老年患者中90天病例死亡率的决定因素:回顾性队列研究
Prashanti Marella1, Mahesh Ramanan2, Kiran Shekar3
1Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; Mater Clinical Unit, University of Queensland, Brisbane, Australia.
概括
治疗限制,非居民身份或ICU类型,在老年重症监护室 (ICU) 患者中显著影响90天病例死亡率. 这些因素对于了解重症监护机构中老年人治疗结果的变化至关重要.
科学领域:
- 老年医学 老年医学
- 关键护理医学 关键护理医学
- 公共卫生 公共卫生
背景情况:
- 系统性审查显示,老年重症监护室 (ICU) 患者的病例死亡率有所变化.
- 之前的研究缺乏结构和过程决定因素的数据,例如患者住院时间,ICU类型和治疗限制.
- 了解这些因素对于改善老年人ICU入院的护理和结果至关重要.
研究的目的:
- 调查患者住院状态,三级重症监护室 (ICU) 状态和治疗限制对老年ICU患者90天病例死亡率的影响.
- 确定影响ICU入院的老年人死亡率的关键决定因素.
- 提供证据来完善老年人ICU人群的风险分层和护理策略.
主要方法:
- 昆士兰州75岁及以上居民被录入四个重症监护室的回顾性队列研究.
- 分析包括患者住院状态,三级ICU状态,治疗限制和其他已知的决定因素.
- 90天全因病例死亡率使用多变量混合效应逻辑回归来评估.
主要成果:
- 住院患者 (21%对12%),非选择性入院 (32%对7%) 和非三级ICU (27%对16%) 的病例死亡率更高.
- 随着年龄的增长,死亡率随着年龄的增长而增加,在90岁以上的人群中,死亡率达到29.6%.
- 治疗限制与病例死亡率有很强的关联,而住院状态和三级ICU状态不是显著的预测因素.
结论:
- 治疗限制是影响老年ICU患者病例死亡率的关键因素.
- 在评估结果时,这些限制应该与已确定的因素 (如并发症和疾病严重程度) 一起考虑.
- 进一步的研究和对治疗限制的临床考虑可以改善对老年ICU患者护理的评估.
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