• 大連醫(yī)科大學(xué)附屬第一醫(yī)院中心ICU(遼寧大連 116011);

目的  了解急性腦血管病機(jī)械通氣患者院內(nèi)死亡的預(yù)后因素。方法  對(duì)大連醫(yī)科大學(xué)附屬第一醫(yī)院中心ICU 2005年1月~2007年12月間所有進(jìn)行機(jī)械通氣治療并且資料完整的94例急性腦血管病內(nèi)科患者的資料進(jìn)行回顧性分析,依據(jù)出院結(jié)果分為死亡組和生存組,對(duì)包括年齡、性別、病史、入院時(shí)的血?dú)夥治鲆约凹毙陨韺W(xué)和慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分等各項(xiàng)指標(biāo)進(jìn)行單因素及多因素Logistic回歸分析。結(jié)果  50例(53.2%)死亡,44例(46.8%)生存出院。單因素分析發(fā)現(xiàn)兩組間APACHEⅡ評(píng)分、血糖、總住院時(shí)間、ICU住院時(shí)間、機(jī)械通氣時(shí)間、氣管切開(kāi)、肺內(nèi)感染、病變部位及性質(zhì)有顯著差異(P均 lt;0.05)。多因素Logistic回歸分析表明血糖、肺內(nèi)感染、幕下病變、機(jī)械通氣時(shí)間是增加院內(nèi)死亡風(fēng)險(xiǎn)的獨(dú)立預(yù)后危險(xiǎn)因素(P均 lt;0.05),而ICU住院時(shí)間為保護(hù)性因素(P lt;0.05)。結(jié)論  需機(jī)械通氣的急性腦血管病患者病死率高,治療過(guò)程中應(yīng)積極控制血糖及肺內(nèi)感染等預(yù)后危險(xiǎn)因素,并對(duì)患者的預(yù)后做出正確評(píng)估。 

引用本文: 張久之,萬(wàn)獻(xiàn)堯,吳向東. 急性腦血管病機(jī)械通氣患者院內(nèi)死亡的預(yù)后因素分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(4): 281-285. doi: 復(fù)制

1. 2 Mayer SA,Copeland D,Bernardini GL,et a1.Cost and outcome of mechanical ventilation for life-threatening stroke.Stroke,2000,31:2346-2353. 3 Hamidon BB,Nabil I,Raymond AA.Risk factors and outcome of dysphagia after an acute ischaemic stroke.Med J Malaysia,2006,61:553-557.
2.
3.
4. Ovary C,Suzuki K,Nagy Z.Regional differences in incidence rates,outcome predictors and survival of stroke.Neuroepidemiology,2004,23:240-246.
5. Karapanaylotides T,Piechowski-Jozwiak B,vail MeUeg G,et al.Stroke patterns,etiology,and prognosis in patients with diabetes mellitus.Neurology,2004,62:1558-1562.
6. Heuschmann PU,Kolominsky-Rabas PL,Misselwitz B,et al.Predictors of in-hospital mortality and attributable risks of death after ischemic stroke:the German Stroke Registers Study Group.Arch Intern Med,2004,164:1761-1768.
7. Kazumi K,Yasuyuki I,Takeshi I,et al.Hyperglycemia independently increases the risk of early in acute spontaneous intracerebral hemorrhage.Journal of the Neurological Sciences,2007,255:90-94.
8. McCowen KC,Malhottra A,Bistrian BR.Stress-induced hyperglycemia.Crit Care,2001,17:107-124.
9. Christensen H,Boysen G.Blood glucose increases early after stroke onset:a study on serial measurements of blood glucose acute stroke.Eur J Neurol,2002,9:297-301.
10. Leigh R,Zaidat OO,Suri MF,et al.Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.Stroke,2004,35:1903-1907.
11. Song EC,Chu K,Jeong SW,et al.Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage.Stroke,2003,34:2215-2220.
12. Garg R,Chaudhuri A,Munschauer F,et al.Hyperglycemia,insulin,and acute ischemic stroke:a mechanistic justification for a trial of insulin infusion therapy.Stroke,2006,37:267-273.
13. Van den Berghe G,Schoonheydt K,Becx P,et al.Insulin therapy protects the central and peripheral nervous system of intensive care patients.Neurology,2005,64:1348-1353.
14. Federico B,Allison S,F(xiàn)ederico G,et al.The Effect of Intensive Insulin Therapy on Infection Rate,Vasospasm,Neurologic Outcome,and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage.Neurosurg Anesthesiol,2007,19:156-160.
15. 黃偉,李曉楓,萬(wàn)獻(xiàn)堯,等.長(zhǎng)期機(jī)械通氣患者的預(yù)后因素分析.中國(guó)呼吸與危重監(jiān)護(hù)雜志,2004,3:167-169.
16. 黃偉,秦詠梅,萬(wàn)獻(xiàn)堯,等.老年長(zhǎng)期機(jī)械通氣患者的預(yù)后影響因素.大連醫(yī)科大學(xué)學(xué)報(bào),2004,26:197-199.
17. Cho DY,Wang YC.Comparison of the APACHEⅢ,APACHEⅡ and Glasgow Come Scale in the acute head injury for prediction of mortality and functional outcome.Intensive Care Med,1997,23:77-84.
18. 孟新科.APACHE評(píng)分系統(tǒng)的研究現(xiàn)狀及展望.中國(guó)急救醫(yī)學(xué)雜志,2001,21:430-431.
19. Michael Z,Rolando B.Tracheostomy in the critically ill patient:who,when,and how?.Clinical Pulmonary Medicine.2006,13:111-120.
  1. 1. 2 Mayer SA,Copeland D,Bernardini GL,et a1.Cost and outcome of mechanical ventilation for life-threatening stroke.Stroke,2000,31:2346-2353. 3 Hamidon BB,Nabil I,Raymond AA.Risk factors and outcome of dysphagia after an acute ischaemic stroke.Med J Malaysia,2006,61:553-557.
  2. 2.
  3. 3.
  4. 4. Ovary C,Suzuki K,Nagy Z.Regional differences in incidence rates,outcome predictors and survival of stroke.Neuroepidemiology,2004,23:240-246.
  5. 5. Karapanaylotides T,Piechowski-Jozwiak B,vail MeUeg G,et al.Stroke patterns,etiology,and prognosis in patients with diabetes mellitus.Neurology,2004,62:1558-1562.
  6. 6. Heuschmann PU,Kolominsky-Rabas PL,Misselwitz B,et al.Predictors of in-hospital mortality and attributable risks of death after ischemic stroke:the German Stroke Registers Study Group.Arch Intern Med,2004,164:1761-1768.
  7. 7. Kazumi K,Yasuyuki I,Takeshi I,et al.Hyperglycemia independently increases the risk of early in acute spontaneous intracerebral hemorrhage.Journal of the Neurological Sciences,2007,255:90-94.
  8. 8. McCowen KC,Malhottra A,Bistrian BR.Stress-induced hyperglycemia.Crit Care,2001,17:107-124.
  9. 9. Christensen H,Boysen G.Blood glucose increases early after stroke onset:a study on serial measurements of blood glucose acute stroke.Eur J Neurol,2002,9:297-301.
  10. 10. Leigh R,Zaidat OO,Suri MF,et al.Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.Stroke,2004,35:1903-1907.
  11. 11. Song EC,Chu K,Jeong SW,et al.Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage.Stroke,2003,34:2215-2220.
  12. 12. Garg R,Chaudhuri A,Munschauer F,et al.Hyperglycemia,insulin,and acute ischemic stroke:a mechanistic justification for a trial of insulin infusion therapy.Stroke,2006,37:267-273.
  13. 13. Van den Berghe G,Schoonheydt K,Becx P,et al.Insulin therapy protects the central and peripheral nervous system of intensive care patients.Neurology,2005,64:1348-1353.
  14. 14. Federico B,Allison S,F(xiàn)ederico G,et al.The Effect of Intensive Insulin Therapy on Infection Rate,Vasospasm,Neurologic Outcome,and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage.Neurosurg Anesthesiol,2007,19:156-160.
  15. 15. 黃偉,李曉楓,萬(wàn)獻(xiàn)堯,等.長(zhǎng)期機(jī)械通氣患者的預(yù)后因素分析.中國(guó)呼吸與危重監(jiān)護(hù)雜志,2004,3:167-169.
  16. 16. 黃偉,秦詠梅,萬(wàn)獻(xiàn)堯,等.老年長(zhǎng)期機(jī)械通氣患者的預(yù)后影響因素.大連醫(yī)科大學(xué)學(xué)報(bào),2004,26:197-199.
  17. 17. Cho DY,Wang YC.Comparison of the APACHEⅢ,APACHEⅡ and Glasgow Come Scale in the acute head injury for prediction of mortality and functional outcome.Intensive Care Med,1997,23:77-84.
  18. 18. 孟新科.APACHE評(píng)分系統(tǒng)的研究現(xiàn)狀及展望.中國(guó)急救醫(yī)學(xué)雜志,2001,21:430-431.
  19. 19. Michael Z,Rolando B.Tracheostomy in the critically ill patient:who,when,and how?.Clinical Pulmonary Medicine.2006,13:111-120.
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