在重症监护病房内患有动脉瘤下结出血的患者的代码状态转换
Min-I Su1,2, Chia-Ying Hsiao1,3, Jui-Chu Ma4
1Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
Palliative medicine reports
|September 8, 2025
概括
晚年,较低的血压,较高的SAPS II分数和临终关怀服务预测了动脉瘤下关节出血 (aSAH) 患者的代码状态变化. 这有助于临床医生定时进行关键讨论,以便更好地为家庭做出决策.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 动脉瘤下关节出血 (aSAH) 与高死亡率和复杂的终身护理决策有关.
- 现有的指导方针缺乏针对aSAH患者的不复苏 (DNR) 或不插管 (DNI) 命令的具体建议.
- 这种差距使得临床医生难以及时和适当地与家庭就代码状态进行讨论.
研究的目的:
- 为了确定预测密码状态转换的因素在重症监护室 (ICU) 患者aSAH.
- 通过与患者偏好保持一致的知情讨论,支持基于价值的决策.
- 改善医疗保健提供者和家庭之间的代码状态对话的时间.
主要方法:
- 使用密集护理IV (MIMIC-IV) 数据库的医学信息中心进行回顾性队列研究 (2008-2022).
- 分析包括731名被诊断患有aSAH的成年患者.
- 考克斯回归模型确定了从全代码到DNR/DNI的代码状态过渡的预测因素.
主要成果:
- 25.8%的初始完整代码状态的患者在住院期间过渡到DNR/DNI.
- 过渡的独立预测因素包括晚年 (HR=1.024),较低的平均血压 (HR=0.987),较高的SAPS II分数 (HR=1.018),以及接受住院服务 (HR=6.951).
- 具有代码状态限制的患者经历了更少的侵入性护理,增加了临终关怀利用率和更高的死亡率.
结论:
- 人口和生理因素,如年龄,血压,SAPS II和宿舍服务是aSAH代码状态转换的重要预测因素.
- 早期识别高风险患者有助于主动和价值调整的终身护理讨论.
- 有信息的讨论可以改善家庭在SAH后的危急疾病期间的决策.
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