重症胰腺炎患者非计划重返ICU的现状及危险因素分析

doi:10.3761/j.issn.2096-7446.2025.04.004

摘要/Abstract

摘要：

目的调查重症胰腺炎患者非计划重返ICU的现状特征，并分析其危险因素，为避免胰腺炎患者重返ICU提供理论依据。方法回顾性分析2020年1月1日—2024年2月1日在浙江省某三级甲等综合医院4个院区中自ICU转到普通病房的298例主要诊断为重症胰腺炎患者的病例资料，统计非计划重返ICU率，收集患者的一般资料、疾病相关资料，按照是否发生非计划重返ICU分为重返组和未重返组，采用单因素及Logistic回归分析筛选非计划重返ICU的危险因素。结果 298例患者中共有47例重返ICU，重返率15.8%。二分类Logistic回归分析显示：年龄（OR=1.039）、基础疾病个数（OR=1.244）、合并呼吸衰竭（OR=3.283）是重症胰腺炎患者非计划重返ICU的独立危险因素。结论该组重症胰腺炎患者非计划重返ICU处于较高水平。为避免高危患者重返ICU，临床需重点关注高龄、基础疾病复杂、合并呼吸衰竭的患者。

关键词: 重症胰腺炎, 非计划重返, 重症监护室, 危险因素, 护理

Abstract:

Objective To investigate the clinical characteristics and status of unplanned return to the ICU for patients with acute pancreatitis in general wards，and analyze risk factors to provide a theoretical basis for preventing ICU readmissions. Methods A retrospective analysis was conducted on the medical records of 298 patients primarily diagnosed with acute pancreatitis，transferred from the ICU to general wards between January 1，2020，and February 1，2024，from 170 wards in four campuses of a tertiary hospital in Zhejiang Province. The unplanned ICU return rate was calculated，and patient demographics and disease-related information were collected. According to the occurrence of unplanned return to the ICU，the patients were divided into the return to the ICU group and the non-return to the ICU group. Univariate and logistic regression analyses were employed to identify risk factors for unplanned readmissions. Results Among the 298 patients，47 experienced returns to ICU，resulting in a rate of 15.8%. Binary logistic regression showed that age（OR=1.039），number of comorbidities（OR=1.244），and presence of respiratory failure（OR=3.283） were independent risk factors for unplanned ICU return in acute pancreatitis patients. Conclusion The rate of unplanned return to ICU among acute pancreatitis patients was relatively high in this group of patients. Clinicians should pay special attention to patients with advanced age, complex comorbidities and heart failure，thereby preventing return to ICU.

Key words: Severe Pancreatitis, Unplanned Return, Intensive Care Unit, Risk Factors, Nursing Care

宋运莲, 燕艳, 邵荣雅, 丁维燕. 重症胰腺炎患者非计划重返ICU的现状及危险因素分析[J]. 中华急危重症护理杂志, 2025, 6(4): 409-413.

SONG Yunlian, YAN Yan, SHAO Rongya, DING Weiyan. Analysis of the status and risk factors of unplanned return to ICU in patients with acute pancreatitis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(4): 409-413.

图/表 2

参考文献 25

[1]	屠夏敏. 全身免疫炎症指数(SII)对重症急性胰腺炎的预测价值研究[D]. 扬州: 扬州大学, 2023.
	Tu XM. Predictive value of systemic immune inflammatory index(SII) in severe acute pancreatitis[D]. Yangzhou: Yangzhou University, 2023.
[2]	Crosignani A, Spina S, Marrazzo F, et al. Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit:a narrative review[J]. Ann Intensive Care, 2022, 12(1):98. doi: 10.1186/s13613-022-01072-y pmid: 36251136
[3]	周蒙滔, 王春友. 重症急性胰腺炎两次病死高峰的综合救治[J]. 肝胆胰外科杂志, 2019, 31(1):3-5,20.
	Zhou MT, Wang CY. Comprehensive treatment of two death peaks of severe acute pancreatitis[J]. J Hepatopancreatobiliary Surg, 2019, 31(1):3-5,20.
[4]	周娥, 刘胤佃, 何金爱. 病人非计划重返重症监护室危险因素的Meta分析[J]. 循证护理, 2022, 8(8):1001-1008.
	Zhou E, Liu YD, He JA. Risk factors for unplanned readmit to the ICU:a Meta-analysis[J]. Chin Evid Based Nurs, 2022, 8(8):1001-1008.
[5]	Rui X, Dong F, Ma XD, et al. Quality metrics and outcomes among critically ill patients in China:results of the national clinical quality control indicators for critical care medicine survey 2015-2019[J]. Chin Med J, 2022, 135(9):1064-1075.
[6]	Morgan M, Vernon T, Bradburn EH, et al. A comprehensive review of the outcome for patients readmitted to the ICU following trauma and strategies to decrease readmission rates[J]. J Intensive Care Med, 2020, 35(10):936-942. doi: 10.1177/0885066619899639 pmid: 31916876
[7]	聂子涵. ICU急性呼吸衰竭患者死亡风险预测研究[D]. 郑州: 郑州大学, 2022.
	Nie ZH. Study on death risk prediction of patients with acute respiratory failure in ICU[D]. Zhengzhou: Zhengzhou University, 2022.
[8]	Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure:a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”[J]. Am J Gastroenterol, 2009, 104(3):710-715.
[9]	高永祥, 张晋昕. Logistic回归分析的样本量确定[J]. 循证医学, 2018, 18(2):122-124.
	Gao YX, Zhang JX. Determination of sample size in logistic regression analysis[J]. J Evid Based Med, 2018, 18(2):122-124.
[10]	杨靖, 王玉康, 曾小康. 高脂血症性重症急性胰腺炎的早期血液净化治疗疗效评估[J]. 中国医师杂志, 2021, 23(10):1572-1575.
	Yang J, Wang YK, Zeng XK. Evaluation of early blood purification therapy for hyperlipidemia severe acute pancreatitis[J]. J Chin Physician, 2021, 23(10):1572-1575.
[11]	周卫江, 陆军, 万亚峰. 降钙素原和内毒素在急性胰腺炎并发细菌感染中的诊断价值[J]. 全科医学临床与教育, 2019, 17(1):69-70.
	Zhou WJ, Lu J, Wan YF. Diagnostic value of procalcitonin and endotoxin in acute pancreatitis complicated with bacterial infection[J]. Clin Educ Gen Pract, 2019, 17(1):69-70.
[12]	龚娅婷, 范震. 生物学标志物对急性胰腺炎严重程度早期预测价值的研究进展[J]. 胃肠病学, 2020, 25(8):493-496.
	Gong YT, Fan Z. Advances in research on early predictive value of biomarkers for severity of acute pancreatitis[J]. Chin J Gastroenterol, 2020, 25(8):493-496.
[13]	陈欣, 高天巍, 李沂伟, 等. 血尿酸/血肌酐比值对重症急性胰腺炎患者急性肾损伤的预测分析[J]. 中国卫生检验杂志, 2023, 33(15):1872-1875.
	Chen X, Gao TW, Li YW, et al. Predictive analysis of blood uric acid/serum creatinine ratio on acute kidney injury in patients with severe acute pancreatitis[J]. Chin J Health Lab Technol, 2023, 33(15):1872-1875.
[14]	Oh TK, Song IA, Jeon YT. Impact of Glasgow Coma Scale scores on unplanned intensive care unit readmissions among surgical patients[J]. Ann Transl Med, 2019, 7(20):520. doi: 10.21037/atm.2019.10.06 pmid: 31807502
[15]	陈伟, 谭文君, 李娟, 等. 外科重症监护室患者非计划重返原因及预后[J]. 临床医学研究与实践, 2021, 6(9):145-147.
	Chen W, Tan WJ, Li J, et al. Causes and prognosis of unplanned return of patients in surgical intensive care unit[J]. Clin Res Pract, 2021, 6(9):145-147.
[16]	Husu HL, Valkonen MM, Leppäniemi AK, et al. Occurrence and risk factors of infected pancreatic necrosis in intensive care unit-treated patients with necrotizing severe acute pancreatitis[J]. J Gastrointest Surg, 2021, 25(9):2289-2298. doi: 10.1007/s11605-021-05033-x pmid: 33987740
[17]	de Lima VCBF, Bierrenbach AL, Alencar GP, et al. Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country:a retrospective multicenter cohort study[J]. Intensive Care Med, 2018, 44(7):1090-1096.
[18]	Schepers NJ, Bakker OJ, Besselink MG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis[J]. Gut, 2019, 68(6):1044-1051. doi: 10.1136/gutjnl-2017-314657 pmid: 29950344
[19]	Brown SES, Ratcliffe SJ, Kahn JM, et al. The epidemiology of intensive care unit readmissions in the United States[J]. Am J Respir Crit Care Med, 2012, 185(9):955-964.
[20]	Shah J, Rana SS. Acute respiratory distress syndrome in acute pancreatitis[J]. Indian J Gastroenterol, 2020, 39(2):123-132. doi: 10.1007/s12664-020-01016-z pmid: 32285399
[21]	Gajendran M, Prakash B, Perisetti A, et al. Predictors and outcomes of acute respiratory failure in hospitalised patients with acute pancreatitis[J]. Frontline Gastroenterol, 2021, 12(6):478-486.
[22]	郭丰. 重症急性胰腺炎呼吸衰竭的诊治思考[J]. 中华急诊医学杂志, 2023, 32(10):1287-1290.
	Guo F. Diagnosis and treatment of respiratory failure in severe acute pancreatitis[J]. Chin J Emerg Med, 2023, 32(10):1287-1290.
[23]	Akinosoglou K, Schinas G, Almyroudi MP, et al. The impact of age on intensive care[J]. Ageing Res Rev, 2023,84:101832.
[24]	Stavem K, Hoel H, Skjaker SA, et al. Charlson comorbidity index derived from chart review or administrative data:agreement and prediction of mortality in intensive care patients[J]. Clin Epidemiol, 2017,9:311-320.
[25]	Guidet B, de Lange DW, Boumendil A, et al. The contribution of frailty,cognition,activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs:the VIP2 study[J]. Intensive Care Med, 2020, 46(1):57-69.