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頁籤選單縮合
題 名 | The Investigation of Clinical Characteristics and Outcomes of ICU Readmission among Elderly Patients=老年病人重返加護病房的臨床特性及預後之探討 |
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作 者 | 蔡季倫; 方楸淑; 丁靜宜; 楊俊杰; 陳志金; 陳奇祥; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷 期 | 23:2 2012.06[民101.06] |
頁 次 | 頁47-55 |
分類號 | 419.73 |
關鍵詞 | 老年; 重返; 加護病房; 臨床特性; 結果; 死亡率; Elderly; Readmission; Intensive care unit; Clinical characteristic; Outcomes; Mortality rate; |
語 文 | 英文(English) |
中文摘要 | 研究背景:病人「重返加護病房」是反映加護病房照護品質的重要指標。病人重返加護病房,不但增加醫療費用造成醫療浪費,而且延長病人的住院天數,造成病患死亡率及罹病率增加。然而,有關老年病人重返加護病房的研究卻鮮少被提及和討論。為了解老年重症病人重返加護病房之臨床特性及相關的結果,本論文將針對這項目的做深入的探討。 研究方法:以回溯性方法於 2003年在台灣某醫學中心具 79床之加護病房收集年齡超過 65歲以上的老年人。以病歷回顧的方式記錄病患的臨床特性及結果。同時也進一步的比較重返加護病房的病人中死亡與存活者的差異。 研究結果:老年病人加護病房的重返率為 12.0%。其中 83名為男性,占了 56.5%。研究個案的平均年齡為 74.7 ± 6.1歲。呼吸道問題為老年病人重返加護病房的最主要原因,占了所有重返原因的 46.4%。而老年病人重返加護病房的死亡率為 38.1%。在重返加護病房的個案中,死亡的個案有較高的 APACHE II (25.8 ± 9.5 vs. 19.1 ± 7.8, p=0.036)及TISS分數 (29.3 ± 9.4 vs. 23.1 ± 6.7, p=0.019),然而其 GCS分數 (9.6 ± 6.7 vs. 11.6 ± 13.4, p=0.002)卻是較低的。至於住院天數方面,死亡個案在重返加護病房時有較長的加護病房住院天數 (11.6 ± 13.4 vs. 9.6 ± 6.7, p=0.002),但在住院的總天數方面,卻較存活個案為短 (38.6 ±28.3 vs. 55.4 ± 55.9, p=0.010)。多變項分析顯示重返加護病房時的 APACHE II (勝算比為 1.085, 95%信賴區間為 1.003-1.172, p=0.041)及TISS分數 (勝算比為 1.114, 95%信賴區間為 1.040-1.193, p=0.002)為老年病人重返加護病房的危險相關因子。 研究結論:老年病人重返加護病房有較高的死亡率及罹病率。老年病人重返加護病房時,其疾病嚴重度愈高表示病患有著較高的死亡率。在重返加護病房的原因中,以呼吸道疾病為最主要的原因。至於如何辨別高危險群病人,降低老年病人加護病房重返率,為未來必要的研究重點。 |
英文摘要 | Background: ICU readmission has been identified as a reliable performance indicator for intensive care. ICU readmission not only increases medical expenditure and prolongs the length of the hospital stay,but it also increases the mortality and morbidity of patients. However, ICU readmission of elderly patients has rarely been investigated. To address this issue, our aim was to delineate the clinical characteristicsand outcomes of ICU readmission among elderly patients. Materials and Methods: Patients who were aged 65 years or above and admitted more than once tothe ICU during the same hospitalization were retrospectively collected for the year 2003 from a medical ICU and a surgical ICU with a total of 79 beds at a tertiary care center. Clinical characteristics andoutcomes were recorded. The risk factors associated with mortality on ICU readmission were evaluated. Results: The ICU readmission rate among the elderly patients was 12.0%. Eighty-three (56.5%) ofthese patients were male. The average age was 74.7 ± 6.1 years. Respiratory disease (46.3%) was the most common diagnosis among the elderly patients who were readmitted. The mortality rate was 38.1%.The non-survivors had significantly higher APACHE II scores (25.8 ± 9.5 vs. 19.1 ± 7.8, p=0.036) and therapeutic intervention scoring system (TISS) scores (29.3 ± 9.4 vs. 23.1 ± 6.7, p=0.019), but had a lowerGCS (9.8 ± 5.1 vs. 11.7 ± 3.6, p<0.001) during ICU readmission. The length of ICU stay was significantly longer for the ICU readmitted non-survivors group (11.6 ± 13.4 vs. 9.6 ± 6.7, p=0.002). In addition, thelength of hospital stay was longer for the survivor group (55.4 ± 55.9 vs. 38.6 ±28.3, p=0.010). Multivariate analysis showed that the APACHE II scores (odds ratio 1.085, 95% confidence interval 1.003-1.172,p=0.041) and TISS scores (odds ratio 1.114, 95% confidence interval 1.040-1.193, p=0.002) on ICU readmission were the two risk factors associated with mortality. Conclusions: ICU readmission is associated with a high mortality and morbidity rate among elderly patients. The severity of the disease during readmission is correlated with the higher mortality of these patients.Respiratory disease was the major reason for ICU readmission. Strategies for reducing ICU readmission and improving the outcome among the elderly patients should be highlighted and studied further. |
本系統中英文摘要資訊取自各篇刊載內容。