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[BMJ发表论文]: STEMI患者入住ICU与病死率:回顾队列研究
2019年06月23日 时讯速递, 进展交流 暂无评论

Research

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

BMJ 2019; 365: l1927 https://doi.org/10.1136/bmj.l1927

Cite this as: BMJ 2019;365:l1927

Abstract

Objective 目的

To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).

评价收治ICU对STEMI患者病死率的影响

Design 试验设计

Retrospective cohort study.

回顾性队列研究

Setting 场景

1727 acute care hospitals in the United States.

美国1727所及性病医院

Participants 研究对象

Medicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.

2014年1月至2015年10月间,因STEMI收入ICU及非ICU病房(普通病房/远程医疗病房或过渡病房)的Medicare患者(年龄65岁或以上)。

Main outcome measure 主要预后指标

30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.

30天病死率。采用工具变量分析对混杂因素进行校正,其中以STEMI患者从最近医院到达收治STEMI患者比例最高的四分位ICU所在医院的额外路程作为工具

Results 结果

The analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).

分析纳入109375名STEMI住院患者。ICU收治率最高四分位的医院将超过85%收入ICU。对于因路途便利在ICU收治率最高四分位的医院接受ICU治疗的患者,收入ICU伴随30天病死率降低(绝对降低6.1(95%可信区间−11.9 to −0.3) 百分点)。对于非STEMI患者(证据表明常规收入ICU不改善预后)进行的另一项分析显示,收入ICU不伴随病死率改变(绝对增加1.3 (−0.9 to 3.4) 百分点)。

Conclusions 结论

ICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

对于可以在ICU或非ICU病房治疗的STEMI患者,收入ICU伴随病死率改善。迫切需要确定哪些STEMI患者可从ICU治疗中获益,以及哪些ICU治疗是有益的。

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