结核病危重患者的死亡预后因素初步分析  

A study of the prognostic factors associated with mortality in critically ill patients with tuberculosis

作　　者：孙静[1] 方堃[1] 任丹红[1] 盛西陵 

机构地区：[1]浙江省中西医结合医院重症监护病房,杭州310003 [2]浙江省中西医结合医院结核科重症监护病房,杭州310003

出　　处：《中华结核和呼吸杂志》2011年第1期39-42,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 探讨结核病危重患者死亡预后的影响因素.方法 对2008年6月至2010年2月浙江省中西医结合医院结核科ICU的62例成年结核病危重患者的临床资料进行回顾性分析,其中男48例,女14例,年龄20～91岁,平均（63±4）岁.以入住结核科ICU时间为研究起点,以转出结核科ICU或死亡时间为研究终点,将患者分为存活组（33例）和死亡组（29例）,对年龄、性别、呼吸衰竭类型、有无机械通气、合并其他感染、耐多药结核病、抗结核治疗、急性病生理学和长期健康评价Ⅱ（APACHEⅡ）评分及肝损害等变量进行单因素分析.采用Cox回归分析患者死亡预后的独立危险因素,采用Kaplan-Meier生存分析法计算患者的累积生存率.结果 与结核病危重患者死亡预后有关的因素为：真菌感染,风险比（HR值）为3.44,95%CI为1.23～9.62;Ⅱ型呼吸衰竭,HR值为4.03,95%CI为1.56～10.38;肝损害,HR值为3.96,95%CI为1.30～12.10;APACHEⅡ评分＞25分,HR为4.91,95%CI为1.99～12.11.上述4项因素均可使结核病危重患者住院死亡的风险显著增高（x2值为5.53～11.88,均P＜0.05）,住院累积生存率显著降低（x2值为4.43～22.68,均P＜0.05）.结论 结核病危重患者的病死率高,合并真菌感染、Ⅱ型呼吸衰竭、肝损害和APACHEⅡ评分＞25分是患者死亡预后的危险因素.Objective The purpose of this study was to investigate the prognostic factors associated with mortality in critically ill tuberculosis patients, and therefore to provide information for the early diagnosis and treatment of the disease. Methods The clinical daza of 62 patients with tuberculosis, who were admitted to the intensive care unit （ICU） of Integrated Chinese and Western Medicine Hospital of Zhejiang Province between June 2008 and Feb 2010, were analyzed retrospectively, with the admission date as a start point and the transferring out of ICU date or death date in the ICU as an end point. Forty-eight patients were males and 14 were females, and the patient＇ s age ranging from 20 to years （63 ± 4） years. In addition,these patients were divided into the survival （33 cases） and the death groups （29 cases）. A total of 19 factors including age, sex, respiratory failure types, mechanical ventilation, infection, anti-tuberculous drug resistance, chemotherapy, clinical complications, critical illness score, liver damage, were analyzed for a single risk factor by the univariate model, and calculated for the independent death risk factors using the Cox logistic regression multivariate model. The cumulative survival rate based on the Kaplan-Meier survival model was calculated. Results The mortality was associated with 4 independent factors： fungal infection （ HR =3.44, 95% CI = 1.23 - 9. 62）, type Ⅱ respiratory failure （ HR = 4. 03, 95% CI = 1.56 - 10. 38）, liver damage （HR=3.96, 95% CI=1.30 -12. 10） and elevated APACHEⅡ score （＞25） （HR =4.91,95%CI = 1.99 - 12. 11 ）. These factors significantly （ x2 =5. 53 - 11.88, all P ＜0. 05） increased the in-hospital mortality and decreased the hospital cumulative survival rate（ x2 = 4. 43 -22. 68, all P ＜ 0. 05 ）. Conclusion The high mortality of tuberculosis patients admitted to ICU was associated with fungal infection, type Ⅱ respiratory failure, liver damage, and elevated APACHE Ⅱ score （ ＞ 25）.

关 键 词：结核 危重病 死亡率 预后 

分 类 号：R52[医药卫生—内科学]