Crawford S W, Schwartz D A, Petersen F B, Clark J G
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Am Rev Respir Dis. 1988 Mar;137(3):682-7. doi: 10.1164/ajrccm/137.3.682.
The risk factors for and the outcome of mechanical ventilatory support after marrow transplantation were analyzed in 1,089 consecutive marrow recipients. Of 232 patients receiving ventilatory support at this center, 63 (27%) survived an initial episode of ventilatory support. In contrast, 74% of nonventilated patients survived at least 6 months after transplantation. Among patients with malignant disease (n = 992), a multivariate regression model revealed 3 pretransplant factors that were associated with ventilatory support: age greater than or equal to 21 yr (RR = 1.6, 95% confidence intervals [Cl] = 1.3, 2.0), hematologic malignancy in relapse (RR = 2.1, 95% Cl = 1.7, 2.4), and HLA nonidentical donor-recipient pair (nonidentical graft) (RR = 1.7, 95% Cl = 1.4, 2.1). Survival after ventilatory support was not found to be associated with any pretransplant or post-transplant factors examined. We conclude that although the risk factors for mechanical ventilatory support after marrow transplantation can be defined, we are unable to identify characteristics predictive of survival after such support. The implications of these findings in relation to patient selection and future research activities are discussed.
对1089例连续接受骨髓移植的患者进行了骨髓移植后机械通气支持的危险因素及转归分析。在本中心接受通气支持的232例患者中，63例（27%）在首次通气支持发作后存活。相比之下，74%未接受通气支持的患者在移植后至少存活6个月。在患有恶性疾病的患者（n = 992）中，多变量回归模型显示有3个移植前因素与通气支持相关：年龄大于或等于21岁（相对危险度[RR]=1.6，95%置信区间[CI]=1.3，2.0）、处于复发期的血液系统恶性肿瘤（RR = 2.1，95% CI = 1.7，2.4）以及人类白细胞抗原（HLA）配型不合的供受者对（不合移植）（RR = 1.7，95% CI = 1.4，2.1）。未发现通气支持后的存活与所检查的任何移植前或移植后因素相关。我们得出结论，虽然可以确定骨髓移植后机械通气支持的危险因素，但我们无法识别预测此类支持后存活的特征。讨论了这些发现对患者选择和未来研究活动的意义。
