影响肺结核并发呼吸衰竭患者预后的危险因素分析

The risk factors affecting the prognosis of patients with pulmonary tuberculosis complicated with respiratory failure

目的分析影响肺结核并发呼吸衰竭患者预后的危险因素。方法回顾性分析113例肺结核并发呼吸衰竭患者,根据临床转归分为死亡组与存活组,比较两组临床资料差异,并采用多因素Logistic回归模型分析影响患者死亡的危险因素。结果 113例患者,63例(55. 75%)死亡,50例(44. 25%)生存。死亡组器官损害数目≥3个比例、多耐药结核菌比例、院内获得性肺炎(HAP)比例均高于生存组(P <0. 05),机械通气时间明显增加(P <0. 05),入ICU时急性生理学与慢性健康状况评分(APACHE II)、血乳酸均明显增高(P <0. 05),入ICU时血红蛋白(Hb)、血清白蛋白(ALB)及机械通气24 h时p H值均明显降低(P <0. 05)。多因素Logistic回归分析显示,器官损害数目≥3个、多耐药结核菌、HAP、机械通气时间延长、入ICU时APACHE II评分、血清ALB、乳酸均是肺结核合并呼吸衰竭患者死亡的危险因素(P <0. 05)。结论肺结核并发呼吸衰竭患者预后与器官损害数目、多耐药结核菌、HAP、机械通气时间及入ICU时APACHE II评分、血清ALB、乳酸水平有关。

Objective To analyze the risk factors affecting the prognosis of patients with pulmonary tuberculosis complicated with respiratory failure.Methods A retrospective analysis was performed on 113 patients with pulmonary tuberculosis complicated with respiratory failure.The patients were grouped into dead group and survival group according to clinical outcomes.The clinical data were compared between the two groups.Multivariate logistic regression model was used to analyze the risk factors affecting the patient's death.Results Of the 113 patients,63 patients(55.75%)died and 50 patients(44.25%)survived.The proportions of damage organs≥3,multi-drug resistant TB and hospital acquired pneumonia(HAP)in the death group were significantly higher than those in the survival group(P<0.05).Compared to the survival group,the death group had longer duration of mechanical ventilation,higher acute physiology and chronic health examination(APACHEⅡ)score and blood lactate at admission to ICU but lower levels of hemoglobin(Hb),serum albumin(ALB)and pH after 24 hour of mechanical ventilation at admission to ICU(all P<0.05).Multivariate logistic regression analysis showed that the number of damaged organs≥3,multi-drug resistant TB,HAP,long duration of mechanical ventilation,APACHEⅡscore,ALB and lactic acid at admission to ICU were risk factors for death of the patients(P<0.05).Conclusions The prognosis of patients with pulmonary tuberculosis complicated with respiratory failure is related to the number of damaged organs,multi-drug resistant tuberculosis,HAP,duration of mechanical ventilation,APACHEⅡscore,serum ALB and lactate levels at admission to ICU.