Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Crit Care Clin. 2010 Jan;26(1):133-50. doi: 10.1016/j.ccc.2009.09.001.
An estimated 50,000 to 60,000 patients undergo hematopoietic stem cell transplantation (HSCT) worldwide annually, of which 15.7% are admitted to the intensive care unit (ICU). The most common reason for ICU admission is respiratory failure and almost all develop single or multiorgan failure. Most HSCT recipients admitted to ICU receive invasive mechanical ventilation (MV). The overall short-term mortality rate of HSCT recipients admitted to ICU is 65%, and 86.4% for those receiving MV. Patient outcome has improved over time. Poor prognostic indicators include advanced age, poor functional status, active disease at transplant, allogeneic transplant, the severity of acute illness, and the development of multiorgan failure. ICU resource limitations often lead to triage decisions for admission. For HSCT recipients, the authors recommend (1) ICU admission for full support during their pre-engraftment period and when there is no evidence of disease recurrence; (2) no ICU admission for patients who refuse it and those who are bedridden with disease recurrence and without treatment options except palliation; (3) a trial ICU admission for patients with unknown status of disease recurrence with available treatment options.
全球每年约有 50,000 至 60,000 例患者接受造血干细胞移植（HSCT），其中 15.7% 入住重症监护病房（ICU）。入住 ICU 的最常见原因是呼吸衰竭，几乎所有人都会发生单一或多器官衰竭。大多数入住 ICU 的 HSCT 受者接受有创机械通气（MV）。入住 ICU 的 HSCT 受者的总体短期死亡率为 65%，接受 MV 的患者为 86.4%。患者预后随时间推移而改善。不良预后指标包括年龄较大、功能状态差、移植时疾病活跃、异基因移植、急性疾病严重程度以及多器官衰竭的发展。ICU 资源限制常常导致入院时进行分诊决策。对于 HSCT 受者，作者建议（1）在植入前期间和没有疾病复发证据时入住 ICU 以获得全面支持；（2）拒绝入住 ICU 以及因疾病复发而卧床不起且除姑息治疗外无治疗选择的患者不入住 ICU；（3）对于疾病复发状态未知但有治疗选择的患者，试行入住 ICU。
