慢性阻塞性肺疾病对重症监护病房患者合并呼吸机相关性肺炎病死率的影响

被引：8

作者：

李良

单仁飞

顾慧珍

金文扬

机构：

[1] 浙江省台州医院急救中心

来源：

国际呼吸杂志 | 2013年 / 33卷 / 15期

关键词：

肺炎; 机械通气; 慢性阻塞性肺疾病; 病死率; 重症监护;

D O I：

暂无

中图分类号：

R563.9 [其他];

学科分类号：

100201 [内科学];

摘要：

目的研究慢性阻塞性肺疾病(COPD)对重症监护病房(ICU)患者合并呼吸机相关性肺炎(VAP)病死率的影响。方法本前瞻性研究是在我院急诊重症监护病房用一年半年时间完成的。患者选择标准为接受机械通气超过48 h并且经过微生物学标准证实罹患VAP。ICU病死率的危险因子通过单变量和多变量分析决定。结果 90例经微生物学证实的VAP患者纳入了研究。84%的VAP患者属于迟发。39%的VAP患者痰液中分离出了铜绿假单胞菌。结果显示,没有合并COPD的患者(n=63)病死率显著低于合并COPD的患者(n=27)[42.9%vs 59.3%,P=0.038,OR(95%CI)=1.67(1.04～6.85)]。没有合并COPD的患者接受机械通气天数和ICU入住天数的中位数分别是24(16-41)d和31(17-46)d,合并COPD的患者对应是30(18-43)d和37(21-50)d(P>0.05),没有合并COPD的患者和合并COPD患者(GOLD IV期)机械通气时间和ICU人住时间有显著性差异(P值分别为0.001,0.002)。多变量分析显示:在VAP[3.70(1.86-7.34)]患者中,COPD[OR(95%CI)2.52(1.34～5.12)]是ICU病死率的独立危险因子。结论COPD与ICU中VAP患者病死率相关。

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