欧洲腹部疾病工作组急性胃肠功能损伤工作指南在ICU患者中的应用

发布时间：2018-09-19 11:25

【摘要】：目的依据2012年欧洲腹部疾病工作组(WGAP)制订的急性胃肠功能损伤(AGI)工作指南中AGI的临床分级标准,对ICU患者的胃肠功能和临床结局进行评估,探讨AGI分级在临床实践中的可行性。方法选取2010年1月—2011年12月深圳市人民医院ICU患者874例,根据欧洲2012年AGI工作指南对患者胃肠功能进行分级,共0~Ⅳ级。记录不同病因患者病死率、不同AGI分级患者病死率及ICU住院时间,比较不同AGI分级的原发性与继发性AGI患者病死率。结果 874例患者中共159例死亡,病死率为18.2%。AGI 0级者471例,Ⅰ级者118例,Ⅱ级者180例,Ⅲ级者76例,Ⅳ级者29例。AGI分级与病死率、ICU住院时间呈正相关(rs=0.580、0.374,P0.001)。403例AGI患者中原发性AGI患者181例,继发性AGI患者222例。原发性AGIⅡ级和Ⅲ级患者病死率分别为7.7%(7/91)、53.1%(17/32),均低于继发性AGIⅡ级和Ⅲ级者病死率52.8%(47/89)、84.1%(37/44)(χ2=43.613、8.637,P0.05);原发性AGIⅠ级患者病死率为0,继发性AGIⅠ级患者病死率为7.3%(6/82),两者比较,差异无统计学意义(χ2=1.466,P=0.106);原发性AGIⅣ级患者病死率为90.9%(20/22),继发性AGIⅣ级患者病死率为85.7%(6/7),两者比较,差异无统计学意义(P=0.579)。结论随着AGI分级升高,患者病死率增高,ICU住院时间延长。欧洲2012年AGI工作指南推荐的AGI定义及分级在临床实践中具有可行性和有效性,仍需进一步研究探讨。
[Abstract]:Objective To evaluate the gastrointestinal function and clinical outcomes of patients with acute gastrointestinal impairment (AGI) according to the clinical grading criteria of AGI in the 2012 European Working Group on Abdominal Diseases (WGAP). 874 patients were graded according to Euro 2012 AGI guidelines, with a total of 0-IV grade. The mortality of patients with different etiology, AGI grade and ICU hospitalization time were recorded. The mortality rates of primary and secondary AGI patients with different AGI grades were compared. Results A total of 159 patients died, with a mortality rate of 18.2%. There were 471 cases of AGI, 118 cases of grade I, 180 cases of grade II, 76 cases of grade III and 29 cases of grade IV. AGI classification was positively correlated with mortality and length of stay in ICU (rs = 0.580, 0.374, P 0.001). Among the 403 cases of AGI, 181 cases were primary AGI, 222 cases were secondary AGI. The mortality rates of primary AGI were 7.7% (7/91) and 53.1% (17/32), respectively, which were lower than those of primary AGI. The mortality of secondary AGI class II and class III was 52.8% (47/89), 84.1% (37/44) (2 = 43.613, 8.637, P 0.05); the mortality of primary AGI class I patients was 0, and that of secondary AGI class I patients was 7.3% (6/82). There was no significant difference between the two groups (2 = 1.466, GIP = 0.106); the mortality of primary AGI class IV patients was 90.9% (20/22), and secondary AGI class IV patients was 7.3% (6/82). The mortality rate was 85.7% (6/7), and there was no significant difference between the two groups (P = 0.579). Conclusion With the increase of AGI classification, the mortality of patients increased and the length of stay in ICU prolonged.
【作者单位】：广东省深圳市人民医院(暨南大学医学院附属二院)重症医学科;广东省深圳市人民医院(暨南大学医学院附属二院)胸外科;
【分类号】：R57

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