摘要目的 观察比较沭阳县人民医院重症加强治疗病房(ICU)老年与非老年危重患者的死亡风险.方法 采用回顾性队列研究方法,选择2014年1月至2016年12月沭阳县人民医院综合ICU收治的年龄在15岁以上的初诊急危重症患者作为研究对象,所有数据来自ICU患者出入院登记簿和电子病历.观察研究期间ICU危重患者的发病情况及死亡原因,根据患者年龄分为老年组(65岁以上)和非老年组(15~65岁),采用logistic回归分析两组患者的死亡风险.结果 研究期间共2707例危重患者紧急入住沭阳县人民医院ICU,排除不符合纳入标准的患者,最终共2466例患者纳入分析,男女比例为1.6:1,平均年龄(61.8±17.3)岁,平均格拉斯哥昏迷评分(GCS)为6(4,8)分,平均ICU住院时间为3(1,6)d.2466例危重患者中,最常见的发病原因是自发性脑出血(占25.5%)和外伤性脑损伤(占17.0%),二者在入ICU 7 d内的病死率分别为46.0%和39.5%.与非老年患者(1415例)比较,老年患者(1051例)因外伤性脑损伤、脑梗死、心力衰竭/心血管危象、呼吸危重症死亡的发生率明显高于非老年组(分别为9.4%比4.7%、2.9%比0.8%、5.0%比2.1%、2.5%比1.0%),因农药/药物中毒死亡的发生率明显低于非老年组(0.2%比1.2%,均P<0.01);进一步logistic回归分析显示,老年患者外伤性脑损伤〔风险比(HR)=1.878,95%可信区间(95%CI)=1.233~2.864,P=0.003〕、脑梗死(HR=0.435,95%CI=0.229~0.826,P=0.011)、心力衰竭/心血管危象(HR=0.399,95%CI=0.238~0.668,P=0.000)以及呼吸危重症(HR=0.239,95%CI=0.126~0.453,P=0.000)的死亡风险比非老年患者更高.结论 自发性脑出血和外伤性脑损伤是ICU危重患者最常见的发病原因,其病死率也较高;老年危重患者外伤性脑损伤、脑梗死、心力衰竭/心血管危象、呼吸危重症的死亡风险比非老年患者更高.

abstractsObjective To investigate the risk of death between older and non-older critical patients in intensive care unit (ICU) in Shuyang People's Hospital.Methods A retrospective cohort study was conducted. The critical patients who aged 15 or above, and admitted to ICU of Shuyang People's Hospital from January 2014 to December 2016 were enrolled, and all the data was collected from theregistration and electronic medical records in the ICU. The prevalence and causes of death in ICU critical patients during the study period were observed. The patients were divided into elderly group (65 years and older) and non-elderly group (15-65 years), and logistic regression analysis was performed for the risk of death in the two groups.Results During the study period, 2707 critical patients in emergency were admitted to the ICU of Shuyang People's Hospital, and patients not satisfied the inclusion criteria were excluded. Finally, a total of 2466 patients were enrolled in the analysis with the male and female ratio of 1.6 : 1, an average age of (61.8±17.3) years, a median Glasgow coma scale (GCS) score of 6 (4, 8), and with a median ICU stay of 3 (1, 6) days. In 2466 critical patients, the most common cause of critical state was spontaneous intracerebral hemorrhage (25.5%) and traumatic brain injury (17.0%), with a fatality rate of 46.0% and 39.5% within first 7 days respectively. Compared with the non-elderly patients (n = 1415), the incidences of death of the elderly patients (n = 1051) due to traumatic brain injury, cerebral infarction, heart failure/cardiovascularcrisis, and respiratory critically ill were significantly increased (9.4% vs. 4.7%, 2.9% vs. 0.8%, 5.0% vs. 2.1%, 2.5% vs. 1.0%, respectively), while the incidence of death for pesticide/drug poisoning in the elderly group was significantly lower than that in the non-elderly group (0.2% vs. 1.2%, allP < 0.01). Stepwise logistic regression analysis showed that traumatic brain injury [hazard ratio (HR) = 1.878, 95% confidence interval (95%CI) = 1.233-2.864,P = 0.003), cerebral infarction (HR = 0.435, 95%CI = 0.229-0.826, P = 0.011), heart failure/cardiovascular crisis (HR = 0.399, 95%CI = 0.238-0.668,P = 0.000), and respiratory critically ill (HR = 0.239, 95%CI = 0.126-0.453,P= 0.000) in the older patients were significantly high risk factors of death as compared with those in non-older patients.Conclusions In the general ICU, the most common cause is spontaneous intracerebral hemorrhage and traumatic brain injury in critical patients with a high fatality rate. The risk of death in elderly patients with severe traumatic brain injury, cerebral infarction, heart failure/cardiovascular crisis, respiratory critically ill is higher than that of the non-elderly patients.