重症肺结核合并COPD患者机械通气死亡结局的影响因素分析

Analysis of Influencing Factors on Death Outcome of Mechanical Ventilation in Patients with Severe Pulmonary Tuberculosis Complicated with COPD

目的探讨研究重症肺结核合并慢性阻塞性肺疾病(Chronic Obstructive Pulmoriary Disease,COPD)患者机械通气死亡结局的影响。方法回顾性分析2020年5月-2021年5月福建省漳州市医院呼吸内科、感染科重症病房收治的60例重症肺结核合并COPD患者的临床资料,均进行机械通气治疗,后根据患者最终结局进行分组,其中40例成功生存患者,纳入生存组,20例最终病死患者,纳入病死组,对比两组患者一般资料、治疗情况、实验室指标、CT影像,分析出造成患者病死的相关危险因素。结果两组重症病房住院时间、插管时间、系统或器官功能障碍、耐多药肺结核、呼吸机相关性肺炎、呼吸机后气胸、肺大泡及肺损坏程度比较,差异有统计学意义(P均<0.05);多因素Logistic回归分析显示,重症病房住院时间、耐多药肺结核、呼吸机相关性肺炎,均是重症肺结核合并COPD患者行机械通气治疗后出现病死的独立危险因素(OR=1.063、4.623、3.967,P均<0.05)。结论耐多药肺结核、呼吸机相关性肺炎均是重症肺结核合并COPD患者行机械通气治疗后死亡的相关因素。

Objective To investigate the effect of mechanical ventilation on death outcome in patients with severe pul-monary tuberculosis complicated with chronic obstructive pulmonary disease(COPD).Methods Retrospectively ana-lyzed the clinical data of 60 patients with severe tuberculosis combined with COPD admitted to the intensive care unit of the Department of Respiratory Medicine and the Department of Infectious Diseases in Zhangzhou Hospital Fujian Province from May 2020 to May 2021.All patients were treated with mechanical ventilation.According to the final outcome of the patients,40 successfully survived patients were included in the survival group,and 20 eventually died patients were included in the death group.The general data,treatment,laboratory indicators and CT images of the two groups were compared to analyze the risk factors of death.Results The of intensive care unit length of stay,intubation time,system or organ dysfunction,multidrug-resistant tuberculosis,ventilator-associated pneumonia,postventilator pneumothorax,pulmonary alveoli,and degree of lung damage between the two groups were compared,the differences were statistically significant(all P<0.05).Multifaceted Logistic regression analysis showed that hosplization time in in-tensive care unit,MDR-TB and ventilators associated pneumonia were independent risk factors for death after me-chanical ventilation in patients with severe pulmonary tuberculosis combined with COPD(OR=1.063,4.623,3.967,all P<0.05).Conclusion Multidrug-resistant pulmonary tuberculosis and ventilator-associated pneumonia are related fac-tors of death in patients with severe pulmonary tuberculosis combined with COPD after mechanical ventilation therapy.