Long-term Quality of Life After Surgical Intensive Care Admission
Long-term Quality of Life After Surgical Intensive Care Admission
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DOI：
10.1001/archsurg.2010.279
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发表时间：
2011-04-01
影响因子：
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通讯作者：
Leenen, Luke P. H.
中科院分区：
文献类型：
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作者：
Timmers, Tim K.;Verhofstad, Michiel H. J.;Leenen, Luke P. H.
目的：量化外科重症监护室（ICU）收治的大型患者队列的长期（> 6年）健康相关生活质量（HRQOL）。此外，我们的目的是探讨不同的手术分类对长期健康状况的影响，并与一般人群normal.Design进行比较：前瞻性观察性队列研究。平均随访8年（范围：6-11年）后，使用EuroQol-6D（EQ-6D）收集患者报告的HRQOL数据。前瞻性记录患者特征、手术分类、ICU住院时间和生存率。计算EQ效用评分（采用EQ-5D美国指数关税测量）、EQ视觉模拟量表评分和特定领域健康问题的患病率。通过多变量广义线性回归分析评估手术分类对EQ效用评分和EQ视觉模拟量表评分的影响。采用Logistic回归分析探讨手术分类对特定领域健康问题的影响。长期HRQOL的外科ICU患者进行了比较与年龄和性别匹配的一般荷兰人口使用t检验analysis.Results：八百三十四例患者生存的ICU，并可进行随访。在575例患者（69%）中，测量了HRQOL。对于所有手术分类，在6 - 11年后，近一半的患者仍然存在活动（52%），日常活动（52%），疼痛/不适（57%）和认知（43%）问题。与年龄和性别匹配的一般人群相比，HRQOL较差，EQ效用评分差异为0.11（范围，0-1）。肿瘤手术患者的HRQOL最好（EQ效用评分，0.83），血管患者的HRQOL最差（EQ效用评分，0.72）。创伤（比值比在2.47-3.47之间）和血管手术（比值比在2.27-5.37之间）患者的流动性，自我护理，日常活动和cognition.Conclusions的问题的患病率显着增加：超过6年后，外科ICU入院，HRQOL这个病人的人口大大减少。许多患者仍然有各种健康问题，包括认知功能下降。与一般人群相比，应进行治疗进展，以减少外科ICU幸存者目前的健康缺陷。
Objectives: To quantify the long-term (> 6 years) health-related quality of life (HRQOL) of a large cohort of patients admitted to a surgical intensive care unit (ICU). In addition, we aimed to explore the influence of different surgical classifications on long-term health status and to make comparisons with general population norms.Design: Prospective observational cohort study.Setting: A Dutch teaching hospital.Patients: All surviving surgical ICU patients admitted to the Dutch teaching hospital between 1995 and 2000.Main Outcome Measures: Patient-reported data on HRQOL were collected with the EuroQol-6D (EQ-6D) after a mean follow-up of 8 years (range, 6-11 years). Patient characteristics, surgical classification, length of ICU stay, and survival were prospectively registered. The EQ utility scores (measured with the EQ-5D US index tariff), EQ visual analog scale scores, and prevalences of domain-specific health problems were calculated. The effect of surgical classification on EQ utility scores and EQ visual analog scale scores was assessed by multivariable generalized linear regression analysis. Logistic regression was used to explore the influence of surgical classification on domain-specific health problems. Long-term HRQOL of surgical ICU patients was compared with an age-and sex-matched general Dutch population using t test analysis.Results: Eight hundred thirty-four patients survived the ICU and were available for follow-up. In 575 patients (69%), the HRQOL was measured. For all surgical classifications combined, after 6 to 11 years, nearly half of all patients still had problems with mobility (52%), usual activity (52%), pain/discomfort (57%), and cognition (43%). Compared with the age-and sex-matched general population, HRQOL was worse, with a difference of 0.11 on the EQ utility score (range, 0-1). Oncological surgery patients had the best (EQ utility score, 0.83) and vascular patients had the worst (EQ utility score, 0.72) HRQOL. Trauma (odds ratio between 2.47-3.47) and vascular surgery (odds ratio between 2.27-5.37) patients showed significantly increased prevalences of problems in mobility, self-care, usual activities, and cognition.Conclusions: More than 6 years after a surgical ICU admission, HRQOL of this patient population is largely reduced. Many patients still have a variety of health problems, including decreased cognitive functioning. Treatment advances should be made to reduce the current health deficit of surgical ICU survivors compared with the general population.