伴呼吸衰竭的住院活动性肺结核患者死亡危险因素分析

Analysis on risk factors of mortality for inpatients with active pulmonary tuberculosis complicated with respiratory failure

目的探讨活动性肺结核伴呼吸衰竭患者死亡的相关因素。方法收集2000—2006年间收治的伴呼吸衰竭的活动性肺结核病例,回顾性分析与死亡密切相关的危险因素。结果共有184例患者入选,死亡88例,死亡组平均生存时间50.8d(1～177d),50%患者死于入院30d内。死亡组的结核多耐药率、多脏器衰竭、院内获得性肺炎及APACHEⅡ等多项指标生存组差异有统计学意义。与死亡相关的独立危险因素有:多次复治病例,晚期及粟粒型结核,院内获得性肺炎,机械通气时间延长,多脏器衰竭。结论合并呼吸衰竭的肺结核患者有较高病死率,很多因素影响其愈后。

Objective To investigate the risk factors of mortality for inpatients with active pul- monary tuberculosis complicated with respiratory failure. Method Patients with active pulmonary tuberculosis complicated with respiratory failure hospitalized between 2000 and 2006 were enrolled and analyzed retrospectively on the risk factor of mortality. Results 184 patients were included and 88 patients died. The mean survival time of patients who died was 50.8 days（ranged 1 to 177 days） ,with 50% of the patients died within the first 30 days after admission. There were many sig- nificant differences in MDR-TB rate, multiple organ dysfunction failure （MODF）,hospital acquired pneumonia（HAP）, and APACHE II between the death and survival groups. The independent fac- tors of mortality were： multiple relapse, advanced and military TB, HAP, prolonged mechanical ventilation,and MODF. Conclusions The mortality rate of the patients with active pulmonary tuberculo- sis complicated with respiratory failure was very high, and some factors affected its prognosis.