| 摘要: | 研究目的: 即使隨著醫療上對於診斷和治療的進步，化膿性肝膿瘍依然是個具有生命威脅性的疾病。本研究是去評估化膿性肝膿瘍病患須重症照護者，其臨床結果和預後因子的分析。
研究方法: 從2001年1月至2005年12月於1700床的大學教學醫院，以回溯性地病例分析化膿性肝膿瘍病患須住加護病房者的資料。其間共有436位成人病患(≧18歲)被診斷為化膿性肝膿瘍，而其中有72位病患須住加護病房接受重症照護。
研究結果: 72位病患中的20位於加護病房死亡，因此其加護病房死亡率為 28 %。 病患最常見的潛伏疾病為糖尿病 (51%)，最常見的致病菌種為克雷伯士氏肺炎桿菌 (74%)。和生存者比較，死亡者有較高的急性生理和慢性健康評估(APACHE) II數值 (22.2±9 vs. 13.7±6, p<0.001)， 較高的血中肌酸酐濃度 (2.9±2 vs. 1.9±2 mg/dl, p=0.02), 較常的凝血原時間 (21±5 vs. 16±5 s, p=0.01)於第一天的加護病房住院。除此之外，和死亡相關的因子包括不適當的抗生素治療 (p=0.026), 敗血性休克 (p=0.002), 急性呼吸衰竭 (p<0.001) 和急性腎衰竭 (p=0.043)於第一天的加護病房住院。經由多重因子邏輯回歸分析，可獨立的與死亡相關的因子是於第一天的加護病房住院出現急性呼吸衰竭 (p=0.003, relative risk = 18.7) 和 APACHE II 數值大於16 (p=0.026, relative risk = 7.43)。
研究結論: 化膿性肝膿瘍病患須住加護病房者，其一些因子像是肝膿瘍的大小、致病菌種、併發症和大部分的實驗室數據都和死亡沒有相關。只有在第一天的加護病房住院出現急性呼吸衰竭和 APACHE II 數值大於16為明顯有意義的癒後因子。
Objective: Despite improvements in diagnosis and treatment, pyogenic liver abscess (PLA) remains a life-threatening disease. This study is to evaluate clinical outcome and prognostic factors in PLA patients admitted to intensive care unit (ICU).
Design: Retrospective study.
Setting: Medical and surgical ICU in a 1700-bed university-based hospital.
Patients: Four hundred and thirty-six adult patients (≧18 ys) with the diagnosis of PLA were reviewed, and a total of 72 PLA patients requiring intensive care were enrolled.
Measurements and Main Results: Twenty of 72 enrolled patients died, yielding an ICU mortality rate of 28 %. The most common underlying disease was diabetes mellitus (51%), and the most common microorganism was Klebsiella pneumoniae (74%). Compared with survivors, nonsurvivors had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (22.2±9 vs. 13.7±6, p<0.001), higher serum creatinine (2.9±2 vs. 1.9±2 mg/dl, p=0.02), and longer prothrombin time (21±5 vs. 16±5 s, p=0.01) on the first day of ICU admission. In addition, factors associated with mortality included inadequate antibiotics treatment (p=0.026), septic shock (p=0.002), acute respiratory failure (p<0.001) and acute renal failure (p=0.043) on the first day of ICU admission. On multivariate logistic regression analysis, factors that independently correlated with mortality were the presence of acute respiratory failure (p=0.003, relative risk = 18.7) and APACHE II score > 16 (p=0.026, relative risk = 7.43).
Conclusion: In patients with PLA requiring intensive care, variables including liver abscess size, pathogens, comorbidity and most laboratory data were not associated with mortality. Only the presence of acute respiratory failure and APACHE II score > 16 on the first day of ICU admission were significant prognostic factors. |
