Torrecilla C, Cortés J L, Chamorro C, Rubio J J, Galdos P, Dominguez de Villota E
Intensive Care Unit, Clínica Puerta de Hierro, Madrid, Spain.
Intensive Care Med. 1988;14(4):393-8. doi: 10.1007/BF00262895.
Patients with bone marrow transplant may present with acute, life-threatening complications which frequently (40% of our cases) require intensive care unit treatment and result in an increased mortality (76% in this series). In an attempt to reach a more objective prognostic assessment, we have analyzed those factors related to the worst outcome in the 25 patients with bone marrow transplant admitted into our intensive care unit. Respiratory failure was the most frequent complication (72%), with an 83% mortality. Graft-versus-host disease and neutropenia led to a greater number of infectious complications with a poor outcome. Failure of more than three organ systems, septic shock and mechanical ventilation were statistically associated with mortality (p less than 0.05), and all patients who required mechanical ventilation for more than seven days or needed intensive therapy for more than 10 days died. The presence of septic shock, multisystem failure and severe neutropenia on admission should be considered as initial indicators of a poor prognosis. More than 7 days of mechanical ventilation and an intensive care unit stay of more than 10 days could be critical points in the reassessment of the intensity and prolongation of treatment.
接受骨髓移植的患者可能会出现急性、危及生命的并发症，这些并发症常常（在我们的病例中占40%）需要重症监护病房治疗，并导致死亡率上升（本系列病例中为76%）。为了进行更客观的预后评估，我们分析了入住我们重症监护病房的25例骨髓移植患者中与最差预后相关的因素。呼吸衰竭是最常见的并发症（72%），死亡率为83%。移植物抗宿主病和中性粒细胞减少导致更多的感染并发症，预后较差。三个以上器官系统功能衰竭、感染性休克和机械通气与死亡率在统计学上相关（p<0.05），所有需要机械通气超过7天或需要强化治疗超过10天的患者均死亡。入院时存在感染性休克、多系统功能衰竭和严重中性粒细胞减少应被视为预后不良的初始指标。机械通气超过7天和重症监护病房住院超过10天可能是重新评估治疗强度和延长治疗时间的关键点。
