Jannone Forés Rosa, Botella de Maglia Javier, Bonastre Mora Juan
Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España.
Med Clin (Barc). 2012 Dec 8;139(14):607-12. doi: 10.1016/j.medcli.2012.02.027. Epub 2012 Sep 17.
The survival of haematologic patients admitted to Intensive Care units (ICU) is so poor, that it is debatable whether they should be admitted or not to them. We aimed to find out the survival of these patients in an ICU to know if their admission is justified.
Retrospective study of 600 haematologic patients (49.4 ± 16.4 years, 58.3% male) representing a total of 660 different admissions to the ICU of a university hospital, with a 6 months follow-up. Haematologic diseases were: leukaemia (50.5%), lymphoma (18.7%), myeloma (10.0%), myelodysplasic syndromes (4.2%), aplastic anaemia or bone marrow aplasia (3.3%), thrombotic microangiopathies and HELLP syndrome (7.4%), and others.
A total of 37.5% of patients survived. Survival of thrombotic microangiopathies and HELLP syndrome was higher (81.8% of patients) than that of leukaemias (26.6%) and lymphomas (49.1%). When the reason for ICU admission was respiratory failure with or without septic shock, the survival was lower (20 and 27% of admissions respectively) than when it was septic shock alone (58.7%). Survival of mechanically ventilated patients was 14.6%, that of those treated with any renal replacement therapy 32.4% and that of patients with both treatments 13.8%. From all mechanically ventilated leukaemia or lymphoma patients, 10.3% survived (93 days in the ICU per life saved) but only 7.7% were alive 6 months later.
Considering that the ICU survival was higher than 10% for all the groups studied, we conclude that admission of haematologic patients to the ICU is appropriate.
入住重症监护病房（ICU）的血液系统疾病患者生存率极低，以至于对于是否应收治这类患者存在争议。我们旨在了解这些患者在ICU中的生存情况，以确定收治他们是否合理。
对600例血液系统疾病患者进行回顾性研究（年龄49.4±16.4岁，男性占58.3%），这些患者共660次入住某大学医院的ICU，并进行了6个月的随访。血液系统疾病包括：白血病（50.5%）、淋巴瘤（18.7%）、骨髓瘤（10.0%）、骨髓增生异常综合征（4.2%）、再生障碍性贫血或骨髓发育不全（3.3%）、血栓性微血管病和HELLP综合征（7.4%）以及其他疾病。
共有37.5%的患者存活。血栓性微血管病和HELLP综合征患者的生存率（81.8%）高于白血病（26.6%）和淋巴瘤（49.1%）患者。当入住ICU的原因是伴有或不伴有感染性休克的呼吸衰竭时，生存率较低（分别为入住患者的20%和27%），而单纯感染性休克时生存率为58.7%。接受机械通气患者的生存率为14.6%，接受任何肾脏替代治疗患者的生存率为32.4%，同时接受这两种治疗患者的生存率为13.8%。在所有接受机械通气的白血病或淋巴瘤患者中，10.3%存活（每挽救1例生命在ICU停留93天），但6个月后仅有7.7%存活。
鉴于所有研究组在ICU的生存率均高于10%，我们得出结论，血液系统疾病患者入住ICU是合适的。
