国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2013年
15期
1144-1148
,共5页
李良%单仁飞%顾慧珍%金文杨
李良%單仁飛%顧慧珍%金文楊
리량%단인비%고혜진%금문양
肺炎%机械通气%慢性阻塞性肺疾病%病死率%重症监护
肺炎%機械通氣%慢性阻塞性肺疾病%病死率%重癥鑑護
폐염%궤계통기%만성조새성폐질병%병사솔%중증감호
Pneumonia%Mechanical ventilation%Chronic obstructive pulmonary disease%Mortality%Intensive care
目的 研究慢性阻塞性肺疾病(COPD)对重症监护病房(ICU)患者合并呼吸机相关性肺炎(VAP)病死率的影响.方法 本前瞻性研究是在我院急诊重症监护病房用一年半年时间完成的.患者选择标准为接受机械通气超过48 h并且经过微生物学标准证实罹患VAP.ICU病死率的危险因子通过单变量和多变量分析决定.结果 90例经微生物学证实的VAP患者纳入了研究.84％的VAP患者属于迟发.39％的VAP患者痰液中分离出了铜绿假单胞菌.结果显示,没有合并COPD的患者(n=63)病死率显著低于合并COPD的患者(n=27)[42.9％ vs 59.3％,P=0.038,OR(95％ CI)=1.67(1.04～6.85)].没有合并COPD的患者接受机械通气天数和ICU入住天数的中位数分别是24(16-41)d和31(17 46)d,合并COPD的患者对应是30(18-43)d和37(21-50) d(P＞0.05),没有合并COPD的患者和合并COPD患者(GOLDⅣ期)机械通气时间和ICU入住时间有显著性差异(P值分别为0.001,0.002).多变量分析显示:在VAP[3.70(1.86-7.34)]患者中,COPD[OR (95％ CI)2.52(1.34～5.1 2)]是ICU病死率的独立危险因子.结论 COPD与ICU中VAP患者病死率相关.
目的 研究慢性阻塞性肺疾病(COPD)對重癥鑑護病房(ICU)患者閤併呼吸機相關性肺炎(VAP)病死率的影響.方法 本前瞻性研究是在我院急診重癥鑑護病房用一年半年時間完成的.患者選擇標準為接受機械通氣超過48 h併且經過微生物學標準證實罹患VAP.ICU病死率的危險因子通過單變量和多變量分析決定.結果 90例經微生物學證實的VAP患者納入瞭研究.84％的VAP患者屬于遲髮.39％的VAP患者痰液中分離齣瞭銅綠假單胞菌.結果顯示,沒有閤併COPD的患者(n=63)病死率顯著低于閤併COPD的患者(n=27)[42.9％ vs 59.3％,P=0.038,OR(95％ CI)=1.67(1.04～6.85)].沒有閤併COPD的患者接受機械通氣天數和ICU入住天數的中位數分彆是24(16-41)d和31(17 46)d,閤併COPD的患者對應是30(18-43)d和37(21-50) d(P＞0.05),沒有閤併COPD的患者和閤併COPD患者(GOLDⅣ期)機械通氣時間和ICU入住時間有顯著性差異(P值分彆為0.001,0.002).多變量分析顯示:在VAP[3.70(1.86-7.34)]患者中,COPD[OR (95％ CI)2.52(1.34～5.1 2)]是ICU病死率的獨立危險因子.結論 COPD與ICU中VAP患者病死率相關.
목적 연구만성조새성폐질병(COPD)대중증감호병방(ICU)환자합병호흡궤상관성폐염(VAP)병사솔적영향.방법 본전첨성연구시재아원급진중증감호병방용일년반년시간완성적.환자선택표준위접수궤계통기초과48 h병차경과미생물학표준증실리환VAP.ICU병사솔적위험인자통과단변량화다변량분석결정.결과 90례경미생물학증실적VAP환자납입료연구.84％적VAP환자속우지발.39％적VAP환자담액중분리출료동록가단포균.결과현시,몰유합병COPD적환자(n=63)병사솔현저저우합병COPD적환자(n=27)[42.9％ vs 59.3％,P=0.038,OR(95％ CI)=1.67(1.04～6.85)].몰유합병COPD적환자접수궤계통기천수화ICU입주천수적중위수분별시24(16-41)d화31(17 46)d,합병COPD적환자대응시30(18-43)d화37(21-50) d(P＞0.05),몰유합병COPD적환자화합병COPD환자(GOLDⅣ기)궤계통기시간화ICU입주시간유현저성차이(P치분별위0.001,0.002).다변량분석현시:재VAP[3.70(1.86-7.34)]환자중,COPD[OR (95％ CI)2.52(1.34～5.1 2)]시ICU병사솔적독립위험인자.결론 COPD여ICU중VAP환자병사솔상관.
Objective To determine the impact of chronic obstructive pulmonary disease (COPD)on intensive care unit (ICU) mortality in patients with VAP.Methods This prospective observational study was preformed in EICU of Taizhou Hospital during a 1.5-yearperiod.Eligible patients received mechanical ventilation for ＞48 h and met criteria for microbiologically confirmed VAP.Risk factors for ICU mortality were determined using univariate and multivariable analyses.Results Ninty patients with microbiologically confirmed VAP were included.Most VAP episodes were late-onset (84％),and Pseudomonas aeruginosa was the most frequently isolated bacterium (39％ of VAP episodes).ICU mortality was significantly lower in non-COPD patients (n =63) compared to COPD patients (n =27)[42.9％ vs 59.3％,P =0.038,OR (95％ CI)=1.67(1.04～6.85)].Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 24 (16-41) d and 31 (17-46) d.Whereas in COPD patients were 30(18-43) d and 37(21-50) d (P ＞0.05).The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage Ⅳ) patients (P =0.001 and P =0.002,respectively).Multivariable analysis identified COPD [OR (95％ CI) 2.52 (1.34-5.12)] at VAP diagnosis [3.70 (1.86-7.34)] as independent risk factors for ICU mortality.Conclusions COPD at VAP diagnosis are independently associated with ICU mortality in patients who present VAP.
