重症监护病房中系统性硬化症患者的治疗结果
Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit.
作者信息
Pène Frédéric, Hissem Tarik, Bérezné Alice, Allanore Yannick, Geri Guillaume, Charpentier Julien, Avouac Jérôme, Guillevin Loïc, Cariou Alain, Chiche Jean-Daniel, Mira Jean-Paul, Mouthon Luc
机构信息
From the Réanimation médicale, and Médecine Interne, and Rhumatologie A, Centre National de Référence des maladies systémiques et autoimmunes rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.F. Pène, MD, PhD, Réanimation médicale, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; T. Hissem, MD, Réanimation médicale, Hôpital Cochin, AP-HP; A. Bérezné, MD, Médecine Interne, and Centre National de Référence des maladies systémiques et autoimmunes rares, Hôpital Cochin, AP-HP; Y. Allanore, MD, PhD, Rhumatologie A, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; G. Geri, MD, Réanimation médicale, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; J. Charpentier, MD, Réanimation médicale, Hôpital Cochin, AP-HP; J. Avouac, MD, PhD, Rhumatologie A, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; L. Guillevin, MD, Médecine Interne, and Centre National de Référence des maladies systémiques et autoimmunes rares, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; A. Cariou, MD, PhD; J.D. Chiche, MD, PhD; J.P. Mira, MD, PhD, Réanimation médicale, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; L. Mouthon, MD, PhD, Médecine Interne, and Centre National de Référence des maladies systémiques et autoimmunes rares, Hôpital Cochin, AP-HP, and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité.
出版信息
J Rheumatol. 2015 Aug;42(8):1406-12. doi: 10.3899/jrheum.141617. Epub 2015 Jul 1.
OBJECTIVE
Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU.
METHODS
We performed a single-center retrospective study over 6 years (November 2006-December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed.
RESULTS
Forty-one patients with a median age of 50 years [interquartile range (IQR) 40-65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34-128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%.
CONCLUSION
This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.
目的
系统性硬化症（SSc）患者易发生特定疾病或与治疗相关的危及生命的并发症，可能需要入住重症监护病房（ICU）。我们评估了入住ICU的SSc患者的特征和当前结局。
方法
我们进行了一项为期6年（2006年11月至2012年12月）的单中心回顾性研究。纳入所有入住ICU的SSc患者。研究短期（在ICU期间和住院期间）和长期（6个月和1年）死亡率，并分析预后因素。
结果
纳入41例患者，中位年龄为50岁[四分位间距（IQR）40 - 65]。29例患者（72.5%）表现为弥漫性皮肤型SSc。从诊断到入住ICU的时间为78个月（IQR 34 - 128）。28例患者（71.7%）既往有肺纤维化，12例（31.5%）有肺动脉高压。入住ICU的主要原因是27例患者（65.8%）发生急性呼吸衰竭。13例患者（31.7%）首先尝试无创通气，其中8例成功，而其他患者在24小时内需要气管插管。共有13例患者（31.7%）需要气管插管和机械通气。总体ICU内、住院期间、6个月和1年死亡率分别为31.8%、39.0%、46.4%和61.0%。有创机械通气是最不利的预后因素，住院死亡率为84.6%。
结论
本研究为需要入住ICU的SSc患者提供了可靠的预后数据。SSc患者有创机械通气的灾难性结局需要重新评估入住ICU的指征，并早期识别可能从无创通气中获益的患者。
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