【原】【罂粟摘要】急诊非心脏手术患者的多器官衰竭发生率和预后的变化:一项10年回顾性观察研究

急诊非心脏手术患者的多器官衰竭发生率和预后的变化:一项10年回顾性观察研究

贵州医科大学 麻醉与心脏电生理课题组

翻译：李奕   编辑：马艳燕   审校;曹莹

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背景：在过去几十年中，多器官衰竭（MOF）发病率和死亡率的独立预测因子的流行病学数据发生了变化。本研究的目的是评估十年（2008-2017年）MOF发病率和预后的潜在变化。此外，还考虑了资源利用率。

方法：如果患者是成年人，在2008年1月1日至2017年12月31日期间入住ICU，并具有关于MOF的完整数据集，则符合入选条件。MOF被定义为分别伴有和不伴有中枢神经系统（CNS）衰竭的器官衰竭。MOF的发病定义为早期(入住ICU≤48小时）和晚期（入住ICU> 48小时）。

结果：在本研究中纳入的13270名患者中，44.6%的患者发生了伴有中枢神经系统衰竭的MOF，31.4%的患者未发生中枢神经系统衰竭。中枢神经系统衰竭和非中枢神经系统衰竭患者的MOF相关死亡率分别为(调整后IRR 0.972[95% CI 0.948-0.996]，P=0.022)和(调整后IRR 0.957[95% CI 0.931-0.983]，P=0.0013)。此外，早发性MOF的发病率(调整后的IRR 0.970 [95% CI 0.950至0.991]，P=0.006)和死亡率(调整后的IRR 0.968 [95% CI 0.940至0.996]，P=0.025)下降，而晚发性MOF的发病率和死亡率保持不变。ICU (P=0.024)和住院(P=0.032)时间减少，而机械通气时间保持不变(P=0.41)。

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结论：尽管在过去的几十年里重症监护有所改善，但迟发性MOF的发病率仍然是一种资源密集、病态且致命的疾病。为了改善迟发性MOF的预后，需要对病因、器官衰竭的体征以及何时何地开始治疗进行更多研究。

原始文献来源：

Miia M Jansson , Pasi P Ohtonen , Hannu P SyrjÄlÄ , et al. Changes in the incidence and outcome of multiple organ failure in emergency non-cardiac surgical admissions: a 10-year retrospective observational study.[J].Minerva Anestesiol. 2021Feb;87(2):174-183.

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Changes in the incidence and outcome of multiple organ failure in emergency non-cardiac surgical admissions: a 10-year retrospective observational study

Background: During the past decades, epidemiologic data of independent predictors of multiple organ failure (MoF), incidence, and mortality have changed. the aim of the study was to assess the potential changes in the incidence and outcomes of MoF for one decade (2008-2017). in addition, resource utilization was considered.

Method:Patients were eligible for inclusion if they were adults, admitted to the icU between January 1, 2008 and December 31, 2017, and had complete data sets regarding MOF. MOF was defined as organ failure separately with and without central nervous system (CNS) failure. The onset of MOF was defined as being early (≤48 h of ICU admission) and late (>48 h after icU admission).

Results:Of a total of 13,270 patients enclosed in this study, 44.6% of the patients developed MoF with and 31.4% without cns failure. MoF-related mortality decreased in patients with (adjusted irr 0.972 [95% ci 0.948 to 0.996], P=0.022) and without (adjusted irr 0.957 [95% ci 0.931 to 0.983], P=0.0013) cns failure. in addition, the incidence (adjusted irr 0.970 [95% ci 0.950 to 0.991], P=0.006) and mortality (adjusted irr 0.968 [95% ci 0.940 to 0.996], P=0.025) of early-onset MoF decreased, while the incidence and mortality of late-onset MoF remained constant. the length of icU (P=0.024) and hospital (P=0.032) stays decreased while the length of mechanical ventilation remained constant (P=0.41).

Conclusion:Despite all improvements in intensive care during the last decades, the incidence of late-onset MoF remains a resource-intensive, morbid, and lethal condition. More research on etiologies, signs of organ failure, and where and when to start treatment is needed to improve the prognosis of late-onset MoF.

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