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重症监护病房高危肺栓塞的死亡相关危险因素

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU.

作者信息

Ergan Begüm, Ergün Recai, Çalışkan Taner, Aydın Kutlay, Tokur Murat Emre, Savran Yusuf, Koca Uğur, Cömert Bilgin, Gökmen Necati

机构信息

School of Medicine, Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey.

Dışkapı Yıldırım Beyazıt Education and Research Hospital, Medical Intensive Care Unit, Ankara, Turkey.

出版信息

Can Respir J. 2016;2016:2432808. doi: 10.1155/2016/2432808. Epub 2016 Nov 29.

Abstract

. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. . PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. . Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% ( = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50-1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96-463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01-0.98) were found as independent predictors of mortality. . In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

摘要

我们试图确定重症监护病房(ICU)收治的高危肺栓塞(PE)患者死亡的可能危险因素。通过计算机断层扫描肺动脉造影诊断的PE患者来自两个ICU,并分为两组:1组为高危患者,2组为中/低危患者。共纳入56例患者。其中,41例(73.2%)为1组,15例(26.7%)为2组。与2组相比,1组患者使用血管升压药治疗的需求(0%对68.3%;P<0.001)和有创机械通气的需求(6.7%对36.6%;P = 0.043)更为频繁。1组患者的治疗选择为溶栓治疗29例(70.7%),抗凝治疗12例(29.3%)。1组的ICU死亡率为31.7%(n = 13)。在多因素逻辑回归分析中,APACHE II评分>18(OR 42.47,95%CI 1.50 - 1201.1)、有创机械通气(OR 30.10,95%CI 1.96 - 463.31)和溶栓治疗(OR 0.03, 95%CI 0.01 - 0.98)被发现是死亡的独立预测因素。在高危PE中,入院时的APACHE II评分和有创机械通气需求可能预测ICU中的死亡。溶栓治疗似乎对这些患者有益。

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