化疗及造血干细胞移植后的血液病患者ICU治疗及转归

Treatment and prognosis of the patients with hematological diseases after chemotherapy and hematopoietic stem cell transplantation in ICU

目的分析化疗及造血干细胞移植后的血液病患者ICU治疗及转归,探讨如何使这些患者在最佳时机进入ICU并得到最佳治疗。方法将ICU患者分为血液病组和非血液病组,计算每位患者的APACHEⅡ评分,统计每位患者的呼吸机、抗生素、PICCO(脉搏指示连续心排血量监测)、CBP(连续性血液净化)的使用情况、出ICU时的生存状况及血液系统相关指标(WBC、Hb、PLT、PT、APTT)。比较两组的APACHEⅡ评分、死亡率、血液系统相关指标及呼吸机、PICCO、多联抗生素(3种以上)、CBP的使用率。结果血液病患者和非血液病患者APACHEⅡ评分分别为(21.4±8.1)和(15.8±8.5)、多联抗生素使用率分别为55.8%和31.4%、死亡率分别为58.7%和38.5%、PICCO使用率分别为21.5%和8.3%、WBC分别为(2.92±0.8)和(12.9±9.7)、Hb分别为(52.3±12.6)和(127.4±15.2)、PLT分别为(18.2±13.8)和(169.1±81.5),两组比较有显著性差异(P<0.05);血液病患者和非血液病患者呼吸机使用率分别为58.5%和52.3%、CBP的使用率分别为12.4%和16.9%、PT分别为(11.7±2.5)和(12.2±2.1)、APTT分别为(31.4±5.3)和(32.7±4.1),两组比较无显著性差异(P>0.05)。结论化疗及造血干细胞移植后的血液病患者较之非血液病患者病情严重、死亡率高,应在达到入住ICU标准后,在APACHEⅡ评分较低及血液系统相关指标未完全恶化时,尽早进入ICU治疗,以控制病情进展,安全度过危重期,降低死亡率。

[Objective] To analyze treatment and prognosis of the patients with hematological diseases after chemotherapy and hematopoietic stem cell transplantation （HSCT） in ICU and discusses how to make these patients in the best chance into the ICU and get the best treatment. [ Methods ] All the patients in ICU were divided into hematological diseases group and non-hematological diseases group. The APACHE I1 and the blood system related indicators of every patients were calculated. The use of ventilator, antibiotics, PICCO, CBP was statistics. The sur- vival condition of every patient when out of the ICU was statistics too. [Result] The APACHE 1I, WBC, Hb, PLT, mortality, utilization rate of PICCO and several antibiotics （3 class above） of the hematological diseases group were （21.4±8.1）, （2.92±0.8）, （52.3±12.6）, （18.2±13.8）, 58.7%, 55.8% and 21.5%, which was different apparently with the non- hematological diseases group whose APACHE II, mortality, utilization rate of PICCO and several antibiotics （3 class above） were （15.8±8.5）, （12.9±9.7）, （127.4±15.2）, （169.1±81.5）, 38.5%, 31.4% and 8.3%. The utilization rate of ventilator and CBP were 58.5% and 12.4% in hematological diseases group which wasn＇t different apparently with the non- hematological diseases group whose utilization rate of ventilator and CBP were 52.3% and 16.9% （P 〉0.05）. The PT and AP± in hematological diseases group were （11.7±2.5） and （31.4±5.3） which wasn＇t different apparently with the non-hematological diseases group whose PT and APTF were （12.2±2.1） and （32.7±4.1）. [Conclusions ] The patients with hematological diseases after chemotherapy and HSCT were in a worse way than the non-hematological diseases group, whose mortality were higher than the non-hematological diseases group too. Thepatients with hema- tological diseases after chemotherapy and HSCT should be treated in ICU when their APACHE Ⅱ were lower and the blood system related indicators not completely deterioration so that the progress of disease could be controlled and the mortality could be decreased.