Chang Youjin, Huh Jin-Won, Hong Sang-Bum, Lee Dae Ho, Suh Cheolwon, Kim Sang-We, Lim Chae-Man, Koh Younsuck
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
J Crit Care. 2014 Jun;29(3):414-9. doi: 10.1016/j.jcrc.2014.01.005. Epub 2014 Jan 13.
To evaluate the outcomes and prognostic factors of 28-day mortality following medical intensive care unit (MICU) admission of patients with lung cancer and pneumonia-induced respiratory failure.
Patients admitted to the MICU of a tertiary referral hospital between 2000 and 2009 were retrospectively studied.
In total, 143 patients were included. Their mean age was 65±8 years and 94% were male. The 28-day mortality rate was 57%. Multivariate analysis was performed to identify variables associated with 28-day mortality. At 72 hours after admission, a history of radiotherapy (OR=2.80, 95% CI: 1.15-6.78), PaO2/FiO2 (P/F) ratio at admission of <100 mmHg (OR=5.62, 95% CI: 2.10-15.07), P/F ratio after 72 hours of <100 mmHg (OR=4.61, 95% CI: 1.24-17.15), and arterial pH after 72 hours of <7.30 (OR=5.78, 95% CI: 1.15-28.89) were associated with increased mortality.
The prognosis of patients with lung cancer and severe pneumonia after 72 hours of MICU management mainly depends on the severity of the underlying lung injury, which is reflected by a history of radiotherapy and a low P/F ratio, rather than on cancer stage or disease status.
评估肺癌合并肺炎所致呼吸衰竭患者入住医学重症监护病房（MICU）后28天死亡率的结局及预后因素。
对2000年至2009年间入住一家三级转诊医院MICU的患者进行回顾性研究。
共纳入143例患者。他们的平均年龄为65±8岁，94%为男性。28天死亡率为57%。进行多变量分析以确定与28天死亡率相关的变量。入院72小时时，放疗史（OR = 2.80，95% CI：1.15 - 6.78）、入院时动脉血氧分压/吸入氧浓度（PaO2/FiO2）比值<100 mmHg（OR = 5.62，95% CI：2.10 - 15.07）、72小时后PaO2/FiO2比值<100 mmHg（OR = 4.61，95% CI：1.24 - 17.15）以及72小时后动脉血pH<7.30（OR = 5.78，95% CI：1.15 - 28.89）与死亡率增加相关。
肺癌合并重症肺炎患者在MICU治疗72小时后的预后主要取决于潜在肺损伤的严重程度，这通过放疗史和低PaO2/FiO2比值反映，而非癌症分期或疾病状态。
