{"id":17280,"date":"2019-06-23T05:25:37","date_gmt":"2019-06-22T21:25:37","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17280"},"modified":"2019-07-02T15:13:27","modified_gmt":"2019-07-02T07:13:27","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-stemi%e6%82%a3%e8%80%85%e5%85%a5%e4%bd%8ficu%e4%b8%8e%e7%97%85%e6%ad%bb%e7%8e%87%ef%bc%9a%e5%9b%9e%e9%a1%be%e9%98%9f%e5%88%97%e7%a0%94%e7%a9%b6","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17280","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]: STEMI\u60a3\u8005\u5165\u4f4fICU\u4e0e\u75c5\u6b7b\u7387\uff1a\u56de\u987e\u961f\u5217\u7814\u7a76"},"content":{"rendered":"\n

Research<\/strong><\/p>\n\n\n\n

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study<\/h1>\n\n\n\n

BMJ<\/em> 2019; 365: l1927 https:\/\/doi.org\/10.1136\/bmj.l1927<\/a><\/h3>\n\n\n\n

Cite this as: BMJ<\/em> 2019;365:l1927<\/p>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).<\/p>\n\n\n\n

\u8bc4\u4ef7\u6536\u6cbbICU\u5bf9STEMI\u60a3\u8005\u75c5\u6b7b\u7387\u7684\u5f71\u54cd<\/p>\n\n\n\n

Design<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1<\/h3>\n\n\n\n

Retrospective cohort study.<\/p>\n\n\n\n

\u56de\u987e\u6027\u961f\u5217\u7814\u7a76<\/p>\n\n\n\n

Setting<\/strong> \u573a\u666f<\/h3>\n\n\n\n

1727 acute care hospitals in the United States.<\/p>\n\n\n\n

\u7f8e\u56fd1727\u6240\u53ca\u6027\u75c5\u533b\u9662<\/p>\n\n\n\n

Participants<\/strong> \u7814\u7a76\u5bf9\u8c61<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

2014\u5e741\u6708\u81f32015\u5e7410\u6708\u95f4\uff0c\u56e0STEMI\u6536\u5165ICU\u53ca\u975eICU\u75c5\u623f\uff08\u666e\u901a\u75c5\u623f\/\u8fdc\u7a0b\u533b\u7597\u75c5\u623f\u6216\u8fc7\u6e21\u75c5\u623f\uff09\u7684Medicare\u60a3\u8005\uff08\u5e74\u9f8465\u5c81\u6216\u4ee5\u4e0a\uff09\u3002<\/p>\n\n\n\n

Main outcome measure<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

30\u5929\u75c5\u6b7b\u7387\u3002\u91c7\u7528\u5de5\u5177\u53d8\u91cf\u5206\u6790\u5bf9\u6df7\u6742\u56e0\u7d20\u8fdb\u884c\u6821\u6b63\uff0c\u5176\u4e2d\u4ee5STEMI\u60a3\u8005\u4ece\u6700\u8fd1\u533b\u9662\u5230\u8fbe\u6536\u6cbbSTEMI\u60a3\u8005\u6bd4\u4f8b\u6700\u9ad8\u7684\u56db\u5206\u4f4dICU\u6240\u5728\u533b\u9662\u7684\u989d\u5916\u8def\u7a0b\u4f5c\u4e3a\u5de5\u5177<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

The analysis included 109\u2009375 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 \u221211.9 to \u22120.3) 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 (\u22120.9 to 3.4) percentage points).<\/p>\n\n\n\n

\u5206\u6790\u7eb3\u5165109375\u540dSTEMI\u4f4f\u9662\u60a3\u8005\u3002ICU\u6536\u6cbb\u7387\u6700\u9ad8\u56db\u5206\u4f4d\u7684\u533b\u9662\u5c06\u8d85\u8fc785%\u6536\u5165ICU\u3002\u5bf9\u4e8e\u56e0\u8def\u9014\u4fbf\u5229\u5728ICU\u6536\u6cbb\u7387\u6700\u9ad8\u56db\u5206\u4f4d\u7684\u533b\u9662\u63a5\u53d7ICU\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u6536\u5165ICU\u4f34\u968f30\u5929\u75c5\u6b7b\u7387\u964d\u4f4e\uff08\u7edd\u5bf9\u964d\u4f4e6.1\uff0895%\u53ef\u4fe1\u533a\u95f4\u221211.9 to \u22120.3\uff09 \u767e\u5206\u70b9\uff09\u3002\u5bf9\u4e8e\u975eSTEMI\u60a3\u8005\uff08\u8bc1\u636e\u8868\u660e\u5e38\u89c4\u6536\u5165ICU\u4e0d\u6539\u5584\u9884\u540e\uff09\u8fdb\u884c\u7684\u53e6\u4e00\u9879\u5206\u6790\u663e\u793a\uff0c\u6536\u5165ICU\u4e0d\u4f34\u968f\u75c5\u6b7b\u7387\u6539\u53d8\uff08\u7edd\u5bf9\u589e\u52a01.3 (\u22120.9 to 3.4) \u767e\u5206\u70b9\uff09\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"<\/figure>\n\n\n\n
\"\"<\/figure>\n\n\n\n
\"\"<\/figure>\n\n\n\n
\"\"<\/figure>\n\n\n\n

Conclusions<\/strong> \u7ed3\u8bba<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u5bf9\u4e8e\u53ef\u4ee5\u5728ICU\u6216\u975eICU\u75c5\u623f\u6cbb\u7597\u7684STEMI\u60a3\u8005\uff0c\u6536\u5165ICU\u4f34\u968f\u75c5\u6b7b\u7387\u6539\u5584\u3002\u8feb\u5207\u9700\u8981\u786e\u5b9a\u54ea\u4e9bSTEMI\u60a3\u8005\u53ef\u4eceICU\u6cbb\u7597\u4e2d\u83b7\u76ca\uff0c\u4ee5\u53ca\u54ea\u4e9bICU\u6cbb\u7597\u662f\u6709\u76ca\u7684\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

Research Intensive care use and mortality among patient […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17280"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17280"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17280\/revisions"}],"predecessor-version":[{"id":17300,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17280\/revisions\/17300"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17280"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17280"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}