肺结核并发呼吸衰竭患者死亡的危险因素分析

Analysis on death risk factors of pulmonary tuberculosis patients with respiratory failure

目的分析需要机械通气的肺结核并发呼吸衰竭患者死亡相关的危险因素,为减少患者死亡提供依据。方法收集2010年1月至2012年12月在我院ICU收治的需要机械通气的肺结核并发呼吸衰竭的患者共106例,按照预后情况分为死亡组62例(58.5%)和生存组44例(41.5%),分析与患者死亡密切相关的影响因素。结果两组患者在结核多耐药率、急性生理和慢性健康(APACHE II)评分、院内获得性肺炎(HAP)、心功能不全、肝功能不全、感染性休克、多器官功能障碍综合征(MODS)、机械通气时间、肺叶受累程度差异均有统计学意义(P<0.05,P<0.01),其中多耐药、HAP、MODS、机械通气时间延长、多肺叶受累是需要机械通气的肺结核合并呼吸衰竭患者死亡的独立相关因素(P<0.05)。结论需要机械通气的肺结核合并呼吸衰竭患者病死亡率非常高,多耐药、HAP、MODS、机械通气时间延长、多肺叶受累影响其预后。

Objective To analyze the death risk factors of pulmonary tuberculosis （PTB） patients with mechanical ventilation and to provide the basis for reducing the mortality of PTB patients with respiratory failure. Methods From January 2010 to December 2012, 106 respiratory failure patients with active PTB requiring mechanical ventilation were admitted to the intensive care unit （ICU） of Guangzhou Chest Hospital. The subjects were divided into survival group （44 cases, 41.5%） and death group （62 cases, 58.5% ） in accordance with the prognosis. The influencing factors related to patient death were analyzed. Results There were significant differences of multi-drug resistance rates, the score of acute physiology and chronic health evaluation （APACHE II）, hospital acquired pneumonia （HAP）, cardiac insufficiency, hepatic insufficiency, septic shock, multiple organ dysfunction syndrome （MODS）, mechanical ventilation time and the severity of lung involvement between two groups （P〈0.05 or P〈0.01 ）. The multi-drug resistance, HAP, MODS, prolonged mechanical ventilation time and multiple lobar involvement were independently related factors for death of PTB patients with respiratory failure requiring mechanical ventilation （P〈0.05）. Conclusion The mortality of the patients with active PTB with respiratory failure requiring mechanical ventilation is very high, the multi-drug resistance, HAP, MODS, prolonged mechanical ventilation time and multiple lobar involvement could influence the prognosis of patients.