頁籤選單縮合
題名 | The Intensive Care of the Critically III General Surgery Patients=一般外科重症患者的加護治療 |
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作者 | 劉銘; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 24:5 民80.09-10 |
頁次 | 頁815-823 |
分類號 | 419.39 |
關鍵詞 | 一般外科重症患者; 加護治療; |
語文 | 英文(English) |
中文摘要 | 外科重症患者的加護治療,需要大量的人力與物力。一般而言,加護治療的醫療成本是病房治療的五倍,所以患者收住外科加護病房,需要審慎的評估,以免醫療資源的浪費,尤其是當加護中心床位不敷使用時,決定收容一個病人往往意味若另一個病人喪失了加強醫療密切照顧的機會,所以如何選擇病患收入ICU是一個值得我們深入研究的問題。 由於加護中心的治療結果,受到收醫患者本身病情輕重的影響,所以無論是評估加護病房治療的效果或評估病情的輕重,都需要有一套客觀方法可以將疾病的輕重程度做明顯的區分。目前評估的方法有許多種,最常用的是根據患者急性生理及病理狀況、年齡以及以往健康狀況綜合評估的APACHE II方法。經由此一方法才可以比較各加護中心的醫療水準;不同的治療方式是否產生不同的治療結果;各年度收醫患者的嚴重程度之比較;及同一加護病房,治療效果是否持續進步。 在過去三年中一共有176位一般外科的患者住進加護病房,其中最常見的診斷是胃腸道穿孔(23.86%),急性膽管炎(19.88%),消化道出血(14.77 %),而住進加護病房的主要原因是敗血症(56.8%)。病人的平均年齡為61歲,平均住院天數為32天,平均住加護病房11天,這176位病中有96位(54.5%)的APACHE II score在10-19之間與其它文獻報告近似。但是卻有90位病人不治死亡,死亡率高達51.1%,分析死亡率特別高的原因可能有許多,但是其中可以立刻改進的則有:(1)訂定病患進入加護中心的優先順序以及嚴格執行轉出的原則,俾有效利用加護中心床位。(2)訓練及設置專責的重症加護治療醫師,以專業的知識與全心的投入,提升加護治療的效果。 |
英文摘要 | In the face of expensive costs and limited resources of intensive care, there are increasing demands for the stronger evidence of the indications and benefits of intensive care. In order to provide this evidence, the severity of the patients must be stratified. Several systems have been developed to evaluate the severity of the illness of the critically ill patients. APACHE II is one of the most commonly used and widely accepted system which takes the acute physiological derangements, chronic health status and age of the patients into consideration. 176 critically ill general surgery patients were treated in intensive care unit during the past three years. The most common underlying diseases were gastrointestinal perforation (23.86%), biliary tract infection (19.88%), and upper G-I bleeding (14.77%). The main reason for admission to the ICU was sepsis (56.8%). The severity of their diseases were classified according to the APACHE II scoring system and 54.5% of these patients had an APACHE II score between 10 and 19 which is similar to the reports of other medical centers. The average hospital stay of these patients were 32 days, and patients stayed in the intensive care unit for an average of 11 days. Several factors contributed to the high mortality (51.1%) of these patients: an older patient population, different diagnostic groups, lack of admission and discharge criteria, lead-time bias, and the absence of full-time surgical intensive care specialist in the unit. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。