腫瘤患者術后急性呼吸衰竭死亡的預后因素分析_《中國呼吸與危重監護雜志》

作者：

 徐海燕 , 高勇 , 肖慶龍 , 孫克林

中國醫學科學院腫瘤醫院ICU（北京 100021）;

關鍵詞：

呼吸衰竭病死率預后因素

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目的探討腫瘤患者術后急性呼吸衰竭的住院病死率及其預后因素。方法回顧性分析中國醫學科學院腫瘤醫院ICU2004 年1 月至2006 年12 月收治的1632 例腫瘤術后患者, 急性呼吸衰竭( 氣管插管或氣管切開且機械通氣) 447 例, 對死亡率進行單因素和多因素Logistic 回歸分析。結果 447 例急性呼吸衰竭患者中, 死亡106 例, 病死率為6. 5% 。單因素分析顯示急性疾病( 休克、感染、器官功能衰竭) 、治療( 持續腎臟替代治療、使用血管活性藥物) 、28 d 內未住ICU 天數、 APACHEⅡ≥20 分與術后急性呼吸衰竭的死亡有關, 具有統計學意義( P lt;0. 05) 。多因素Logistic 回歸分析顯示手術時間( P = 0. 008, OR 1. 032, 95% CI 1. 008 ～1. 057) 、APACHEⅡ ≥20 分( P = 0. 000, OR 12. 200, 95% CI 2. 896 ～51. 406) 、器官功能衰竭( P = 0. 000, OR 13. 344, 95% CI 3. 791 ～7. 395) 與急性呼吸衰竭的死亡有關。結論手術時間、器官功能衰竭、APACHEⅡ評分是腫瘤患者術后急性呼吸衰竭死亡的預后危險因素。

引用本文： 徐海燕,高勇,肖慶龍,孫克林. 腫瘤患者術后急性呼吸衰竭死亡的預后因素分析. 中國呼吸與危重監護雜志, 2009, 09(5): 469-472. doi: 復制

1.	Vincent JL, SakrY, Ranieri VM. Epidemiology and outcome of acute respiratory failure in intensive care unit patients. Crit Care Med, 2003, 31: S296-S299.
2.	Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference of ARDS: definition, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149: 814-818.
3.	Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physician /Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest, 1992, 101: 1644-1655.
4.	Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med, 1985, 13: 818-829.
5.	Pascual FE, Matthay MA, Bacchetti P, et al. Assessment of Prognosis in Patients With Community-Acquired Pneumonia Who Require Mechanical Ventilation. Chest, 2000, 117: 503-512.
6.	Vincent JL, Moreno R, Takala J, et al. The SOFA ( Sepsis-related Organ Failure Assessment ) score to describe organ dysfunction/ failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med, 1996, 22: 707-710.
7.	Luhr OR, Antonsen K, Karlsson M, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med, 1999, 159: 1849-1861.
8.	Lewandowski K, Metz J, Deutschmann C, et al. Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med, 1995, 151: 1121-1125.
9.	Vasilyev S, Schaap RN, Mortensen JD. Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey. Chest, 1995, 107: 1083-1088.
10.	陳諧捷, 唐小平, 尹熾標, 等.
11.	宋鵬, 李琦, 王長征, 等.
12.	Knaus WA, Sun X, Hakim RB, et al. Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med, 1994, 150: 311-317.
13.	Epstein SK, Vuong V. Lack of Influence of Gender on Outcomes of Mechanically Ventilated Medical ICU Patients. Chest, 1999, 116 : 732-739.
14.	Montaner JS, Hawley PH, Ronco JJ, et al. Multisystem organ failure predicts mortality of ICU patients with acute respiratory failure second to AIDS-related PCP. Chest, 1992, 102: 1823-1828.
15.	Licker M, Spiliopoulos A, Frey JG, et al. Management and outcome of patients undergoing thoracic surgery in a regional chest medical centre. Eur J Anaesthesiol, 2001, 18: 540-547.
16.	Ferring M, Vincent JL. Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J, 1997, 10: 1297-1300.
17.	例重癥急性呼吸窘迫綜合征臨床資料回顧性分析. 中國呼吸與危重監護雜志, 2006, 5: 35-38.
18.	DiRusso SM, Nelson LD, Safcsak K, et al. Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure. Crit Care Med, 1995, 23: 1485-1496.
19.	例嚴重急性呼吸綜合征死亡病例的臨床分析. 中國呼吸與危重監護雜志, 2003, 2: 206-210.

1. Vincent JL, SakrY, Ranieri VM. Epidemiology and outcome of acute respiratory failure in intensive care unit patients. Crit Care Med, 2003, 31: S296-S299.
2. Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference of ARDS: definition, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149: 814-818.
3. Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physician /Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest, 1992, 101: 1644-1655.
4. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med, 1985, 13: 818-829.
5. Pascual FE, Matthay MA, Bacchetti P, et al. Assessment of Prognosis in Patients With Community-Acquired Pneumonia Who Require Mechanical Ventilation. Chest, 2000, 117: 503-512.
6. Vincent JL, Moreno R, Takala J, et al. The SOFA ( Sepsis-related Organ Failure Assessment ) score to describe organ dysfunction/ failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med, 1996, 22: 707-710.
7. Luhr OR, Antonsen K, Karlsson M, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med, 1999, 159: 1849-1861.
8. Lewandowski K, Metz J, Deutschmann C, et al. Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med, 1995, 151: 1121-1125.
9. Vasilyev S, Schaap RN, Mortensen JD. Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey. Chest, 1995, 107: 1083-1088.
10. 陳諧捷, 唐小平, 尹熾標, 等.
11. 宋鵬, 李琦, 王長征, 等.
12. Knaus WA, Sun X, Hakim RB, et al. Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med, 1994, 150: 311-317.
13. Epstein SK, Vuong V. Lack of Influence of Gender on Outcomes of Mechanically Ventilated Medical ICU Patients. Chest, 1999, 116 : 732-739.
14. Montaner JS, Hawley PH, Ronco JJ, et al. Multisystem organ failure predicts mortality of ICU patients with acute respiratory failure second to AIDS-related PCP. Chest, 1992, 102: 1823-1828.
15. Licker M, Spiliopoulos A, Frey JG, et al. Management and outcome of patients undergoing thoracic surgery in a regional chest medical centre. Eur J Anaesthesiol, 2001, 18: 540-547.
16. Ferring M, Vincent JL. Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J, 1997, 10: 1297-1300.
17. 例重癥急性呼吸窘迫綜合征臨床資料回顧性分析. 中國呼吸與危重監護雜志, 2006, 5: 35-38.
18. DiRusso SM, Nelson LD, Safcsak K, et al. Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure. Crit Care Med, 1995, 23: 1485-1496.
19. 例嚴重急性呼吸綜合征死亡病例的臨床分析. 中國呼吸與危重監護雜志, 2003, 2: 206-210.

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腫瘤患者術后急性呼吸衰竭死亡的預后因素分析

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腫瘤患者術后急性呼吸衰竭死亡的預后因素分析

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