目的 分析三甲医院重症监护室（ICU）常见实验室危急值分布特点及影响因素,为临床制定相应诊疗对策提供参考依据。方法 采用回顾性调查法,收集2023年1月至2023年12月上海市某三甲医院ICU的实验室危急值报告记录,包括危急值来源患者性别、年龄、手术情况、ICU内所属科室以及危急值项目等内容;运用“二八原则”,将实验室危急值占比居前80%的危急值作为常见实验室危急值,从不同角度（科室、性别、围手术期/非围手术期、年龄段分布）进行分析,得出此80%的危急值相关影响因素（着重关注20%的影响因素）。结果 从5个ICU共收集1 075例实验室危急值数据,危急值占比前80%的项目为肌钙蛋白升高、尿素氮升高、低钾、肌酐升高、白细胞增多、血小板减少,主要分布于骨科、普外科、泌尿外科、神经外科围手术期的患者。围手术期最常见的项目是肌钙蛋白升高（267例,占比27.81%）、低钾（120例,占比12.50%）、肌酐升高（105例,占比10.94%）。按年龄段分,中年人（45~59岁）共发生189例危急值,占比为17.58%;年轻老年人（60~74岁）共发生443例,占比为41.21%;老年人（75~89岁）共278例危急值,占比为25.86%。结论 ICU应关注常见实验室危急值,如肌钙蛋白升高、尿素氮升高、低钾、肌酐升高、白细胞增多、血小板减少,及时采取有预见性的诊疗措施,以提高抢救成功率和患者生存率。
Objective To analyze the distribution profiles and influencing factors of common laboratory critical values in the intensive care units （ICUs） of Class A tertiary hospitals, providing a reference for clinicians to formulate corresponding diagnosis and treatment strategies. Methods A retrospective survey was conducted to collect laboratory critical value reports from the ICUs of a Class A tertiary hospital in Shanghai from January 2023 to December 2023, and analyze patient gender, age, surgical conditions, departments of the ICUs, and critical value items. Using the Pareto principle, the items that accounted for the top 80% of laboratory critical values were considered common laboratory critical values, and were analyzed by department, gender, perioperative/non-perioperative, and age group to determine the influencing factors of these 80% critical values, with a focus on the 20% of influencing factors. Results A total of 1075 cases with laboratory critical value data were collected from 5 ICUs, and the items that accounted for the top 80% of laboratory critical values included elevated troponin, elevated urea nitrogen, hypokalemia, elevated creatinine, leukocytosis, and thrombocytopenia, which were mainly distributed in patients from the department of orthopedics, general surgery, urology, and neurosurgery during perioperative period. The most common items in perioperative period were elevated troponin in 267 cases （27.81%）, hypokalemia in 120 cases （12.50%）, and elevated creatinine in 105 cases （10.94%）. According to age group, there were 189 cases of critical values in middle-aged people （45-59 years）, accounting for 17.58%; 443 cases occurred in young elderly people （60-74 years）, accounting for 41.21%; 278 cases in elderly patients （75-89 years）, accounting for 25.86%. Conclusion The ICUs should pay attention to common laboratory critical values such as elevated troponin, elevated urea nitrogen, hypokalemia, elevated creatinine, leukocytosis, and thrombocytopenia, and take timely and predictable diagnostic and treatment measures to improve the success rate of rescue and patient survival.
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