通过各种标准对重症患者的腹进行分类:一个队列研究
Ryohei Yamamoto1,2,3, Hajime Yamazaki4,5, Takatoshi Koroki6
1Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan. ryoheiyamamoto11@gmail.com.
Journal of intensive care
|October 1, 2025
概括
严重病患者中腹的患病率根据定义有很大差异. 基于重量或一致性的标准在临床使用和研究中可能比基于频率的标准更实用.
科学领域:
- 临界护理医学 临界护理医学
- 胃肠病学 胃肠病学
- 流行病学 流行病学
背景情况:
- 在重症患者中缺乏标准化的腹标准使得流行率评估和死亡率影响研究复杂化.
- 现有的定义对腹对死亡率的影响产生了不一致的发现.
- 这项研究解决了在重症监护病房 (ICU) 中定义和测量腹的清晰度的需要.
研究的目的:
- 用各种定义来确定ICU患者腹的患病率.
- 评估不同腹诊断标准之间的一致性.
- 调查腹和住院死亡率之间的关联.
主要方法:
- 一个单一中心的队列研究,包括700名成人ICU患者,入院时间≥3天.
- 评估六个腹标准:频率,数量 (例如,每天>200克),一致性 (布里斯托尔便图表尺度),ESICM和WHO标准.
- 用于评估与住院死亡率的关联的多变量Cox比例危险模型.
主要成果:
- 腹的发病率在9%至39%之间,取决于所使用的定义.
- 世卫组织和ESICM标准显示出高度一致 (卡帕0.87),但与布里斯托尔便图表尺度 (BSCS) 标准 (卡帕0.52-0.43) 不同.
- 基于体重 (>200g/day,>400g/day) 和BSCS标准的治疗与增加的住院死亡率有关 (aHR 1.73-1.93).
结论:
- 腹的定义显著影响了ICU设置中的患病率估计.
- 基于频率的标准 (世卫组织,ESICM) 与基于数量 (重量) 和基于一致性 (BSCS) 标准的一致性不佳.
- 在临床实践和研究中,基于权重或基于一致性的定义可能更为实用,因为在ICU中精确监测频率存在挑战.
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