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新冠肺炎患者有创与无创通气的重要预后因素与 CT 评分的相关性。

Correlation of important prognostic factors and CT scores in invasive and non-invasive ventilation of COVID-19 patients.

机构信息

Department of Anesthesia and Reanimation, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye.

Department of Radiology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye.

出版信息

Ulus Travma Acil Cerrahi Derg. 2023 Feb;29(2):163-168. doi: 10.14744/tjtes.2022.92770.

Abstract

BACKGROUND

Intensive care workers received the largest share of the COVID-19 pandemic, which caused nightmares to the whole world. In COVID-19 pneumonia cases which had high mortality rates, many prognostic factors and laboratory examinations were tried to evaluate the clinical severity quickly and accurately.This study was planned to investigate a correlation between the initially ventilation strategy and major prognostic parameters and CT scores in patients admitted to intensive care unit (ICU).

METHODS

In our study, we reviewed 50 consecutive non-invasive mv and 50 consecutive invasive mv treatment of COVID-19 pneumonia patients between March 23, 2020,and May 23, 2020, in the ICUs of our hospital. Patients who were divided into twogroups (non-invasive mechanical ventilation [NIMV] and invasive mechanical ventilation [IMV]) as an initial ventilation strategy according to clinical severity and P/F ratios were evaluated comparatively; demographic data, admission and lowest P/F ratios, admission and highest SOFA scores, comorbidity status, scores on CT at diagnosis, length of ICU stays, hospitalization periods, and mortality rates were examined.

RESULTS

About 85% of all patients were 46 years and older. No significant difference was found in terms of gender and comorbidity status. The lowest P/F ratio was significantly lower in IMV group. The admission and highest SOFA values were higher in the IMV group. There was no significant difference between the CT scores and the number of lobes involved. The mortality rate in the IMV group was significantly higher.

CONCLUSION

Patients who started treatment with NIMV had relatively low poor prognostic factors, their mortality was lower. However, the total CT score at diagnosis was expected to be higher in those who were performed IMV, no significant difference was found in our study. We concluded that the severity classification of the patients cannot be made according to CT scores. CT results should be evaluated as a whole according to the patient's clinic, predisposing factors, and response to treatment.

摘要

背景

重症监护病房的工作人员受到了 COVID-19 大流行的最大影响,这场大流行给全世界带来了噩梦。在 COVID-19 肺炎死亡率较高的病例中,尝试了许多预后因素和实验室检查,以快速准确地评估临床严重程度。本研究旨在调查 ICU 收治的患者最初的通气策略与主要预后参数和 CT 评分之间的相关性。

方法

在我们的研究中,我们回顾了 2020 年 3 月 23 日至 5 月 23 日期间我院 ICU 中 50 例连续非侵入性 MV 和 50 例连续侵入性 MV 治疗的 COVID-19 肺炎患者。根据临床严重程度和 P/F 比,将患者分为两组(无创机械通气 [NIMV] 和有创机械通气 [IMV]),比较评估两组患者;比较了人口统计学数据、入院时和最低 P/F 比、入院时和最高 SOFA 评分、合并症情况、诊断时 CT 评分、ICU 入住时间、住院时间和死亡率。

结果

所有患者中约 85%为 46 岁及以上。性别和合并症情况无统计学差异。IMV 组最低 P/F 比明显较低。IMV 组入院时和最高 SOFA 值较高。CT 评分和受累肺叶数无统计学差异。IMV 组死亡率明显较高。

结论

开始接受 NIMV 治疗的患者预后较差的因素相对较低,死亡率较低。然而,我们的研究中,IMV 组的总 CT 评分预计会更高,但没有发现统计学差异。我们得出结论,不能根据 CT 评分对患者进行严重程度分类。应根据患者的临床、易患因素和治疗反应对 CT 结果进行整体评估。

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