间质性肺疾病并呼吸衰竭原因及机械通气治疗价值  

Causes of respiratory failure complicating interstitial lung disease and application value of mechanical ventilation

作　　者：苏瑾[1] 代华平[1] 班承钧[1] 叶俏[1] 詹庆元[1] 王辰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院.北京呼吸疾病研究所呼吸与危重症医学科(苏瑾现在首都医科大学附属北京同仁医院),100020

出　　处：《中华医学杂志》2010年第12期799-803,共5页National Medical Journal of China

基　　金：基金项目：北京市科技计划建设项目（z090507006209012）

摘　　要：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日期问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同顾性分析。结果入选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急件加重（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。入住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（x2=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。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 （ X2 = 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.

关 键 词：肺疾病 间质性 呼吸功能不全 呼吸 人工 呼吸监护病房 

分 类 号：R563.9[医药卫生—呼吸系统]