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題 名 | Influence of Intensive Care-Acquired Hypernatremia on the Short-Term Mortality of Mechanically Ventilated Patients=加護照護發生之高血鈉對呼吸器病患短期死亡率之影響 |
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作 者 | 潘聖衛; 連德正; 陳燕溫; 余文光; 柯信國; 王家弘; | 書刊名 | 胸腔醫學 |
卷 期 | 26:4 2011.08[民100.08] |
頁 次 | 頁187-194 |
分類號 | 415.415 |
關鍵詞 | 加護照護發生之高血鈉; 呼吸器; 加護病房死亡率; ICU-acquired hypernatremia; Mechanical ventilation; ICU mortality; |
語 文 | 英文(English) |
中文摘要 | 前言:加護照護發生之高血鈉與病患死亡率有很高的相關性,使用呼吸器則是加護病房發生高血鈉的危險因子之一。然而在使用呼吸器的病患身上,加護病房高血鈉的發生率及其對死亡的影響尚無研究報告。方法:本文為呼吸治療加護病房之回溯性研究,納入使用呼吸器的病患,測量加護病房高血鈉的發生率及28天之加護病房死亡率。結果:共收案161人,其中有30人(19%)在加護病房期間發生高血鈉,這些發生加護病房高血鈉的病人在進入加護病房時有較高的APACHEII分數、較低的血氧濃度及在加護病房中有較長的呼吸器使用天數。在多重迴歸分析中發現,校正了住入加護病房之APACHEII分數、急性腎損傷及拒絕心肺復醒術因子後,加護病房高血鈉與28天之加護病房死亡率確有獨立的相關性(勝算比6.756、95%信心區間為1.745-26.164、p=0.006)。結論:加護照護發生之高血鈉在使用呼吸器的重症病患身上是常見的,而且加護病房高血鈉與這類病患之死亡率有獨立的相關性。 |
英文摘要 | Background: ICU-acquired hypernatremia (IAH) is reported to be strongly associated with mortality, and mechanical ventilation (MV) is a risk factor for IAH. However, the incidence of IAH and its impact on ICU mortality among mechanically ventilated patients are unknown. Methods: A retrospective observational study was conducted in a respiratory ICU from December 2008 to December 2009. Patients receiving MV were evaluated. The outcome measurements were the occurrence of IAH and 28-day ICU mortality. Results: Of 161 patients enrolled, 30 (19%) had IAH. Patients with IAH had a higher APACHE II score at admission, lower oxygenation status and longer duration of MV in the ICU compared to those without. In a multivariate logistic regression analysis, IAH was independently associated with 28-day ICU mortality (odds ratio 6.756, 95% confidence interval 1.745-26.164, p=0.006) after adjustment for the APACHE II score at admission, acute kidney injury at admission and a Do Not Resuscitate order. Conclusions: IAH is common among critically ill patients requiring MV and is independently associated with ICU mortality in this patient population. |
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