NEUROLOGIC COMPLICATIONS OF CRITICAL MEDICAL ILLNESSES
NEUROLOGIC COMPLICATIONS OF CRITICAL MEDICAL ILLNESSES
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DOI：
10.1097/00003246-199301000-00019
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发表时间：
1993-01-01
影响因子：
8.8
通讯作者：
HANSEN, CA
中科院分区：
文献类型：
--
作者：
BLECK, TP;SMITH, MC;HANSEN, CA
目标.为了确定神经系统并发症的严重医疗疾病，并评估其对死亡率和医疗ICU和住院longs.Design的影响：前瞻性临床评价所有医疗ICU入院2 yrs.Setting.一家大型大学医院的14张床位的普通医疗重症监护室和冠心病监护室。患者（n = 1，850）入院，其中92例主要因神经系统问题入院。在其余1，758例患者中，217例（12.3%）发生神经系统并发症。无。测量和主要结果。在内科ICU中发生神经系统并发症的患者与未发生此类并发症的患者相比，院内死亡风险增加（45.7% vs. 26.6%; p <0.00001）。神经系统并发症患者的ICU住院时间延长了2.5倍（p <0.001），住院时间几乎延长了2倍（p <0.001）。代谢性脑病、癫痫、缺氧缺血性脑病和卒中是最常见的并发症。败血症是脑病的最常见原因，脑血管病变是癫痫发作的最常见原因。只有36%的患者要求进行正式的神经科会诊。神经系统并发症与死亡率增加、ICU和住院时间延长相关。这些条件目前可能没有得到充分认识。ICU有潜力作为神经病学教学和研究的环境。
Objectives. To identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay.Design: Prospective clinical evaluation of all medical ICU admissions for 2 yrs.Setting. A 14-bed, general medical intensive and coronary care unit in a large university hospital.Patients. Patients (n = 1,850) admitted to the hospital, of whom 92 were admitted for primarily neurologic problems. Of the remaining 1,758 patients, 217 (12.3%) experienced a neurologic complication.Interventions. None.Measurements and Main Results. Patients developing a neurologic complication while in the medical ICU demonstrated an increased risk of inhospital mortality when compared with patients who did not suffer such problems (45.7% vs. 26.6%; p < .00001). Patients with neurologic complications experienced 2.5-fold longer medical ICU stay times (p < .001) and almost two-fold longer hospital stay times (p < .001). Metabolic encephalopathy, seizures, hypoxic-ischemic encephalopathy, and stroke were the most common complications. Sepsis was the most frequent cause of encephalopathy, and cerebrovascular lesions were the most common cause of seizures. Formal neurologic consultations were requested in only 36% of these patients.Conclusions. Neurologic complications are associated with increased mortality rates and longer medical ICU and hospital lengths of stay. These conditions are probably underrecognized at present. ICUs have the potential to serve as environments for neurologic teaching and research.