한 대학병원 내과계 중환자실에서 장기간 기계환기를 받은 노인 환자들의 특징 및 예후 (Clinical Characteristics and Prognosis of Elderly Patients Receiving Prolonged Mechanical Ventilation in the Medical Intensive Care Unit at a University Hospital)

서지정보

· 발행기관 : 대한결핵및호흡기학회
· 수록지 정보 : Tuberculosis and Respiratory Diseases / 64권 / 6호 / 445 ~ 450페이지
· 저자명 : 한민수, 문경민, 이양덕, 조용선, 나동집

초록

연구배경: 최근 노인 인구가 급격히 증가하면서 중환자실로 입원하는 노인 환자도 증가하는 추세이다. 내과계 중환자실에서 30일 이상 장기간 기계환기를 받은 노인 환자들의 임상적 특징 및 예후에 대하여 알아보고자 하였다. 방 법: 204년 4월부터 207년 3월까지 을지대학병원 내과계 중환자실에 입원했던 환자들 중에서 연속해서 30일 이상 기계환기를 받았던 65세 이상 환자 41명을 대상으로 임상적 특징과 예후에 대하여 후향적으로 조사하였Tuberculosis and Respiratory Diseases Vol. 64. No. 6, Jun. 2008449다. 결 과: 대상 환자 41명의 평균 연령은 74.6±6.0세이었고, 남자가 27명(65.9%)이었다. 중환자실로 입원한 주된 이유는 급성호흡부전 30명(73.2%)으로 가장 많았고 패혈증 5명(12.2%), 신경계장애 4명(9.8%), 위장관출혈 2명(4.9%) 순이었다. 평균 APACHE I 점수는 26.9±4.5이었다. 중환자실 평균 입원 기간은 49.3±23.0일 이었으며 기계환기의 평균 기간은 57.5±32.8일이었다. 사망한 환자는 25명(60.9%)이었으며 사망과 관련있는 인자는 APACHE I 점수(p=0.038)와 수혈(p=0.007) 등이었다.

영어초록

Background: As the number of older-aged people increases, the number of elderly patients who receive critical care services is expected to increase substantially. The objective of this study was to examine the clinical characteristics and outcomes of elderly patients who receive mechanical ventilation for more than 30 days in the medical intensive care unit (MICU) at a university hospital.Methods: We retrospectively examined forty-one elderly patients (≥65 years old) who were receiving mechanical ventilation, from April 2004 to March 2007, for periods exceeding 30 days at the MICU at Eulji University Hospital. Results: The MICU and hospitalmortality rate were 60.9% and 65.9%, respectively. The mean length of the ICU
stay was 57.5 days and the mean duration of mechanical ventilation was 49.3 days. The most common reason for MICU admission was acute respiratory failure (73.2%), followed by sepsis (12.2%), neurological problems (9.8%),and gastrointestinal bleeding (4.9%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher for the nonsurvivors than for the survivors (28.0 vs. 25.0, respectively, p=0.03). The nonsurvivors
received more red blood cell (RBC) transfusions during their ICU stay than did the survivors (84.0% vs. 43.8%, respectively p=0.007). The factors associated with hospital death were the APACHE II score and if the patient had received a RBC transfusion. Conclusion: The APACHE II score and a RBC transfusion were predictors of increased hospital mortality for the elderly patients who were on prolonged mechanical ventilation. These predictors may assist physicians to make clinical decisions for this patient population.

참고자료

· 없음