|
|
Analysis of prognosis in pulmonary tuberculosis patients combined with acute respiratory failure by mechanical ventilation treatment |
LIU Qiuyue1 ZHANG Zongde2 LUO Baojian1 HAN Fen1 PAN Liping2 WU Endong1 LI Qi3▲ |
1.Department of Intensive Care Unit, Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing Chest Hospital, Capital Medical University, Beijing 101149, China;
2.Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing Chest Hospital, Capital Medical University, Beijing 101149, China;
3.Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing Chest Hospital, Capital Medical University, Beijing 101149, China |
|
|
Abstract Objective To discuss the high risk factor contributing to death in pulmonary tuberculosis patients combined with acute respiratory failure. Methods Clinical data of 120 pulmonary tuberculosis patients combined with acute respiratory failure in Beijing Chest Hospital, Capital Medical University from January 2012 to May 2016 were analyzed retrospectively. The patients were divided into the survival group and the death group according to clinical outcome. The observed data were identified by χ2/t test and multivariate Logistic analysis. Results There were 59 cases in 120 pulmonary tuberculosis patients combined with respiratory failure treated by mechanical ventilation died in ICU, the fatality rate was 49.20%. Independent predictive factors of mortality included the APACHE Ⅱ score, initial respiratory rate, lactic acid, C-reactive protein and PaO2/FiO2 at 24 hours after mechanical ventilation (P < 0.05). Conclusion Patients with high APACHE Ⅱ scores, high respiratory rate, high serum lactate and C-reactive protein levels, and low PaO2/FiO2 at 24 hours after mechanical ventilation have high fatality rates and poor prognosis.
|
|
|
|
|
[1] World Health Organization. Global tuberculosis report 2016 [R]. 2016.
[2] Mugusi FM,Mehta S,Villamor E,et al. Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis [J]. BMC Public Health,2009,9(1):409.
[3] 中华人民共和国卫生部.肺结核诊断标准(WS288-2008)[S].北京:人民卫生出版社,2008:1-3.
[4] Lichtenstein DA,Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure:the BLUE protocol [J]. Chest,2008,134(1):117-125.
[5] Knaus WA,Draper EA,Wagner DP,et al. Prognosis in acute organ-system failure [J]. Ann Surg,1985,202(6):685-696.
[6] 赵鹏飞,付小萌,王超,等.多器官功能障碍综合征诊断标准及评分系统现状[J].临床和实验医学杂志,2013,12(8):630-636.
[7] American Thoracic Society,Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia [J]. Am J Respir Crit Care Med,2005, 171:388-416.
[8] 高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[9] Yang CS,Qiu HB,Huang YZ,et al. Prospective research on the prognosis of septic shock based on the change of lactate concentration in arterial blood [J]. Chin J Surg,2009, 47(9):685.
[10] Jaye DL,Waites KB. Clinical applications of C-reactiveprotein in pediatrics [J]. Pediatr Infect Dis J,1997,16:735-746.
[11] Chou CH,Lin GM,Ku CH,et al. Comparison of the APACHE Ⅱ,GCS and MRC scores in predicting outcomes in patients with tuberculous meningitis [J]. Int J Tuberc Lung Dis,2010;14(1):86-92.
[12] Knaus WA,Draper EA,Wagner DP,et al. APACHE II-A Severity of Disease Classification System:Reply [J]. Crit Care Med,1986,13(10):818.
[13] Kneyber MC,Rimensberger PC. The need for and feasibility of a pediatric ventilation trial: reflections on a survey among pediatric intensivists [J]. Pediatr Crit Care Med,2012,13(6):632-638.
[14] 顾玉虹,王娟,李德宪,等.肺结核并发呼吸衰竭患者死亡的危险因素分析[J].中国慢性病预防与控制,2014, 22(5):555-557.
[15] 杨亦德,金茜,毛娟娟,等.含左氧氟沙星化疗方案治疗复治涂阳肺结核的临床效果[J].中国医药导报,2016, 13(3):130-133.
[16] Tsiodras S,Samonis G,Boumpas DT,et al. Fungal infections complicating tumor necrosis factor alpha blockade therapy [J]. Mayo Clin Proc,2008,83(2):181-194.
[17] 邓菲丹,罗建业.复治涂阳肺结核治疗前后血清TNF-α、IL-10和IL-18变化[J].中国医药科学,2015,5(11):211-213.
[18] 刘维群,冯月娟,韩晓红,等.肺结核合并营养不良患者肠外营养支持的应用研究[J].中国医药导报,2013,10(17):43-45.
[19] 张亮,易来龙,赖小惠,等.单纯肺结核与肺结核合并糖尿病治疗的临床分析[J].中国医药科学,2016,6(19):218-220.DOI:10.3969/j.issn.2095-0616.2016.19.064.
[20] Hatsuda K,Takeuchi M,Ogata K,et al. The impact of nutritional state on the duration of sputum positivity of Mycobacterium tuberculosis [J]. Int J Tuberc Lung Dis,2015, 19(11):1369-1375.
[21] Ryu YJ,Koh WJ,Kang EH,et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure [J]. Respirology,2010,12(3):406-411.
[22] Lee PL,Jerng JS,Chang YL,et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation [J]. Eur Respir J,2003,22(1):141-147. |
|
|
|