2019冠状病毒病中的纵隔气肿和气胸：病例系列描述及匹配队列研究
Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study.
作者信息
Tekin Aysun, Devarajan Anusha, Sakata Kenneth K, Qamar Shahraz, Sharma Mayank, Valencia Morales Diana J, Malinchoc Michael, Talaei Fahimeh, Welle Stephanie, Taji Jamil, Khosa Sandeep, Sharma Nikhil, Brown Meghan, Lal Amos, Bansal Vikas, Khan Syed Anjum, La Nou Abigail T, Sanghavi Devang, Cartin-Ceba Rodrigo, Kashyap Rahul, Gajic Ognjen, Domecq Juan P, Azadeh Natalya
机构信息
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA.
出版信息
Heliyon. 2024 Jun 26;10(13):e33679. doi: 10.1016/j.heliyon.2024.e33679. eCollection 2024 Jul 15.
OBJECTIVE
To describe the characteristics of COVID-19 patients with pneumothorax and pneumomediastinum (PTX/PM) and their association with patient outcomes.
PATIENTS AND METHODS
Adults admitted to five Mayo Clinic hospitals with COVID-19 between 03/2020-01/2022 were evaluated. PTX/PM was defined by imaging. Descriptive analyses and a matched (age, sex, admission month, COVID-19 severity) cohort comparison was performed. Hospital mortality, length of stay (LOS), and predisposing factors were assessed.
RESULTS
Among 6663 patients, 197 had PTX/PM (3 %) (75 PM, 40 PTX, 82 both). The median age was 59, with 71 % males. Exposure to invasive and non-invasive mechanical ventilation and high-flow nasal cannula before PTX/PM were 42 %, 17 %, and 20 %, respectively. Among isolated PTX and PM/PTX patients 70 % and 53.7 % underwent an intervention, respectively, while 96 % of the PM-only group was followed conservatively.A total of 171 patients with PTX/PM were compared to 171 matched controls. PTX/PM patients had more underlying lung disease (40.9 . 23.4 %, 0.001) and lower median body mass index (BMI) (29.5 . 31.3 kg/m, = .007) than controls. Among patients with available data, PTX/PM patients had higher median positive end-expiratory and plateau pressures than controls; however, differences were not significant (10 8 cmHO; p = 0.38 and 28 22 cmHO; = 0.11, respectively). PTX/PM patients had a higher odds of mortality (adjusted odds ratio [95%CI]: 3.37 [1.61-7.07]) and longer mean LOS (percent change [95%CI]: 39 [9-77]) than controls.
CONCLUSION
In COVID-19 patients with similar severity, PTX/PM patients had more underlying lung disease and lower BMI. They had significantly increased mortality and LOS.
目的
描述新型冠状病毒肺炎（COVID-19）合并气胸和纵隔气肿（PTX/PM）患者的特征及其与患者预后的关系。
患者与方法
对2020年3月至2022年1月期间入住梅奥诊所五家医院的成年COVID-19患者进行评估。PTX/PM通过影像学定义。进行描述性分析并进行匹配（年龄、性别、入院月份、COVID-19严重程度）队列比较。评估医院死亡率、住院时间（LOS）和易感因素。
结果
在6663例患者中，197例患有PTX/PM（3%）（75例纵隔气肿，40例气胸，82例两者均有）。中位年龄为59岁，男性占71%。PTX/PM发生前接受有创和无创机械通气以及高流量鼻导管吸氧的比例分别为42%、17%和20%。在单纯气胸和纵隔气肿/气胸患者中，分别有70%和53.7%接受了干预，而仅纵隔气肿组96%采取保守治疗。总共将171例PTX/PM患者与171例匹配对照进行比较。PTX/PM患者比对照组有更多的基础肺部疾病（40.9%对23.4%，P<0.001）且中位体重指数（BMI）更低（29.5对31.3kg/m²，P=0.007）。在有可用数据的患者中，PTX/PM患者的呼气末正压和平台压中位数高于对照组；然而，差异无统计学意义（分别为10对8cmH₂O；P=0.38和28对22cmH₂O；P=0.11）。PTX/PM患者的死亡几率更高（调整后的优势比[95%CI]：3.37[1.61 - 7.07]），平均住院时间更长（百分比变化[95%CI]：39[9 - 77]）。
结论
在严重程度相似的COVID-19患者中，PTX/PM患者有更多的基础肺部疾病且BMI更低。他们的死亡率和住院时间显著增加。
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