CAJ | 학술논문

目的观察临床诊治路径对非HIV免疫受损宿主(ICH)肺内渗出的病因诊断及预后的影响.方法历史对照研究,分别纳入2007、2009年间因肺内渗出伴呼吸衰竭入住ICU的ICH作为研究组和对照组.研究组诊治路径主要由判断可能部位、初步病因分析、有序检查及12 h内结果反馈、48 ～72 h治疗反应评估4步组成.病因诊断分为感染、非感染及无法确定.结果纳入研究组65例,对照组45例.年龄45.3(22 ～71)岁.导致免疫受损的基础病为自身免疫病69例,血液系统恶性疾病21例,实体肿瘤及其他各10例.研究组与对照组在基础疾病、器官功能及人选时疾病严重程度间的差异无统计学意义,而病因诊断率(73.8％比57.8％)、诊断时间(4.0比6.8d)及28 dICU病死率(38.5％比62.2％)差异均有统计学意义(均P＜0.05).结论本研究设计的诊治路径有助于改善ICH伴肺内渗出的病因诊断及预后.
목적 관찰림상진치로경대비HIV면역수손숙주(ICH)폐내삼출적병인진단급예후적영향.방법 역사대조연구,분별납입2007、2009년간인폐내삼출반호흡쇠갈입주ICU적ICH작위연구조화대조조.연구조진치로경주요유판단가능부위、초보병인분석、유서검사급12 h내결과반궤、48 ～72 h치료반응평고4보조성.병인진단분위감염、비감염급무법학정.결과 납입연구조65례,대조조45례.년령45.3(22 ～71)세.도치면역수손적기출병위자신면역병69례,혈액계통악성질병21례,실체종류급기타각10례.연구조여대조조재기출질병、기관공능급인선시질병엄중정도간적차이무통계학의의,이병인진단솔(73.8％비57.8％)、진단시간(4.0비6.8d)급28 dICU병사솔(38.5％비62.2％)차이균유통계학의의(균P＜0.05).결론 본연구설계적진치로경유조우개선ICH반폐내삼출적병인진단급예후.
Objective To explore the effects of diagnostic protocols on etiology and outcome in immunocompromised host (ICH) with pulmonary infiltrate.Methods For this historic control study,ICH with acute respiratory failure (ARF) were eligible as study group (n =65) in 2009 while another ICH cohort was selected as control group (n =45) in 2007.The protocol consisted of four parts:judgment possible site,determining probable etiology,checking and feedbacks on laboratory test in 12 hours and reassessment and adjustment treatment in 48-72 hours.The etiologies included infection,noninfection and unknown causes.Results Their average age was 45.3 years (range:22-71).Causes of immune suppression were autoimmune disease (n =69),hematological disorders (n =21),solid cancers (n =10) and others (n =10).When two groups were compared,basic diseases,organ function and disease severity showed no significant difference,but etiologic diagnoses rate (73.8％ vs 57.8％),time from ICU admission to diagnosis (4.0 vs 6.8 days) and 28-day mortality (38.5％ vs 62.2％) had significant difference (P ＜0.05).Conclusion Implementation of clinical protocol in ICH with ARF is associated with improved etiologic diagnoses and decreased mortality.