CAJ | 학술논문

目的探讨间质性肺疾病(ILD)患者发生呼吸衰竭的原因以及机械通气治疗的价值.方法收集1998年1月1日至2008年6月30日期间入住北京朝阳医院呼吸重症监护病房(RICU)接受机械通气治疗的ILD并呼吸衰竭患者的临床资料,重点就患者的临床特征、呼吸衰竭原因、RICU治疗、预后及死亡原因等进行回顾性分析.结果人选47例患者,男29例,女18例,中位年龄67岁.引起呼吸衰竭的原因依次为呼吸道感染(18例,38.3%)、呼吸道感染+ILD加重(15例,31.9%)、肺栓塞(8例,17.0%)、ILD急性加重(5例,10.6%)和心力衰竭(1例,2.1%),RICU病死率分别为55.6%(10/18)、73.3%(11/15)、5/8、4/5和1/1.人住RICU之初接受无创机械通气治疗者31例,接受有创机械通气治疗者16例,病死率分别为54.8%和87.5%,组间差异有统计学意义(X~2=5.014,P=0.025).全组患者的RICU病死率为66.0%(31/47),住院病死率为70.2%(33/47).结论呼吸道感染、肺栓塞和ILD急性加重是ILD患者发生呼吸衰竭并导致死亡的常见原因.对ILD并呼吸衰竭患者采用无创通气治疗可能优于有创通气治疗.
목적 탐토간질성폐질병(ILD)환자발생호흡쇠갈적원인이급궤계통기치료적개치.방법 수집1998년1월1일지2008년6월30일기간입주북경조양의원호흡중증감호병방(RICU)접수궤계통기치료적ILD병호흡쇠갈환자적림상자료,중점취환자적림상특정、호흡쇠갈원인、RICU치료、예후급사망원인등진행회고성분석.결과 인선47례환자,남29례,녀18례,중위년령67세.인기호흡쇠갈적원인의차위호흡도감염(18례,38.3%)、호흡도감염+ILD가중(15례,31.9%)、폐전새(8례,17.0%)、ILD급성가중(5례,10.6%)화심력쇠갈(1례,2.1%),RICU병사솔분별위55.6%(10/18)、73.3%(11/15)、5/8、4/5화1/1.인주RICU지초접수무창궤계통기치료자31례,접수유창궤계통기치료자16례,병사솔분별위54.8%화87.5%,조간차이유통계학의의(X~2=5.014,P=0.025).전조환자적RICU병사솔위66.0%(31/47),주원병사솔위70.2%(33/47).결론 호흡도감염、폐전새화ILD급성가중시ILD환자발생호흡쇠갈병도치사망적상견원인.대ILD병호흡쇠갈환자채용무창통기치료가능우우유창통기치료.
Objective To investigate the potential causes of respiratory failure in patients with interstitial lung disease (ILD) and evaluate the application value of mechanical ventilation (MV) in its treatment. Methods This study included the clinical data of 47 ILD patients (29 males and 18 females) complicating respiratory failure and admitted to respiratory care unit (RICU) for receiving MV at Beijing Chaoyang Hospital from January 1, 1998 to June 30, 2008. The median age was 67 years old. And a retrospective analysis was conducted for clinical characteristics, potential causes of respiratory failure, RICU treatment, prognosis and causes of death, etc. Results The causes of respiratory failure were as follows: respiratory infections (n = 18, 38. 3%), respiratory infection superimposed aggravated ILD (n = 15, 31.9%), pulmonary embolism (n =8, 17.0%), ILD with acute exacerbation (n =5, 10. 6%) and heart failure (n = 1, 2. 1%). And the mortality rates of RICU were 55. 6% (10/18), 73.3% (11/15), 5/8, 4/5 and 1/1 respectively. Upon initial admission into RICU, 31 cases received noninvasive ventilation and 16 cases tracheal intubation. The mortality rates were 54. 8% and 87.5% respectively. And there was statistically significant difference between the groups (X~2 = 5.014, P = 0. 025). In all patients, the RICU mortality rate was 66. 0% (31/47) and the hospital mortality rate 70. 2% (33/47) . Conclusions Respiratory infection, pulmonary embolism and acute exacerbation of ILD are the main common causes of respiratory failure in ILD patients. Noninvasive ventilation therapy is clinically preferable to invasive ventilation for ILD patients with respiratory failure.