临床路径对免疫受损患者肺内渗出伴呼吸衰竭的病因诊断及预后的影响

Effects of diagnostic protocols on etiology and outcome in immunocompromised host with pulmonary inrdtrate

目的 观察临床诊治路径对非HIV免疫受损宿主（ICH）肺内渗出的病因诊断及预后的影响.方法 历史对照研究,分别纳入2007、2009年间因肺内渗出伴呼吸衰竭入住ICU的ICH作为研究组和对照组.研究组诊治路径主要由判断可能部位、初步病因分析、有序检查及12 h内结果反馈、48 ～72 h治疗反应评估4步组成.病因诊断分为感染、非感染及无法确定.结果 纳入研究组65例,对照组45例.年龄45.3（22 ～71）岁.导致免疫受损的基础病为自身免疫病69例,血液系统恶性疾病21例,实体肿瘤及其他各10例.研究组与对照组在基础疾病、器官功能及人选时疾病严重程度间的差异无统计学意义,而病因诊断率（73.8％比57.8％）、诊断时间（4.0比6.8d）及28 dICU病死率（38.5％比62.2％）差异均有统计学意义（均P＜0.05）.结论 本研究设计的诊治路径有助于改善ICH伴肺内渗出的病因诊断及预后.

Objective To explore the effects of diagnostic protocols on etiology and outcome in immunocompromised host （ICH） with pulmonary infiltrate.Methods For this historic control study,ICH with acute respiratory failure （ARF） were eligible as study group （n =65） in 2009 while another ICH cohort was selected as control group （n =45） in 2007.The protocol consisted of four parts：judgment possible site,determining probable etiology,checking and feedbacks on laboratory test in 12 hours and reassessment and adjustment treatment in 48-72 hours.The etiologies included infection,noninfection and unknown causes.Results Their average age was 45.3 years （range：22-71）.Causes of immune suppression were autoimmune disease （n =69）,hematological disorders （n =21）,solid cancers （n =10） and others （n =10）.When two groups were compared,basic diseases,organ function and disease severity showed no significant difference,but etiologic diagnoses rate （73.8% vs 57.8%）,time from ICU admission to diagnosis （4.0 vs 6.8 days） and 28-day mortality （38.5% vs 62.2%） had significant difference （P 〈0.05）.Conclusion Implementation of clinical protocol in ICH with ARF is associated with improved etiologic diagnoses and decreased mortality.