Paz H L, Crilley P, Weinar M, Brodsky I
Department of Medicine, Hahnemann University, Philadelphia 19102.
Chest. 1993 Aug;104(2):527-31. doi: 10.1378/chest.104.2.527.
Despite encouraging results seen following bone marrow transplantation (BMT), it has been observed that once these patients become critically ill and require medical intensive care unit (MICU) admission, the chances of survival are poor. We hypothesized that while mechanical ventilation would be an important predictor for death in the MICU, those patients not requiring mechanical ventilation could be successfully discharged from the MICU. The records of 36 patients with 43 admissions to the MICU following BMT were analyzed. Of these admissions, 33 (76.7 percent) patients had allogeneic and 10 (23.3 percent) had autologous transplants, respectively. Overall, 14 (32.6 percent) of the admissions resulted in a satisfactory discharge from the MICU. There was no significant difference in the survival rates between those patients undergoing allogeneic or autologous transplantations, 11 (33.3 percent) vs 3 (30.0 percent), respectively. Twenty-seven (62.8 percent) of the admissions resulted in mechanical ventilation and were performed in 20 (66.7 percent) patients with allogeneic BMTs and 7 (70.0 percent) patients with autologous BMTs, which was not significantly different. The survival rate for those requiring mechanical ventilation was significantly less than for those not mechanically ventilated during their MICU stay, 1 (3.7 percent) vs 13 (81.3 percent), respectively (p < 0.001). Those patients who did not survive their MICU stay had a significantly higher mean APACHE II score of 21.2 +/- 4.7 than the survivors' score of 15.8 +/- 3.8 (p < 0.001). The average length of stay for the survivors was 4.4 + 3.0 days, which was significantly less than the 17.8 +/- 24.0 days for those patients not surviving (p < 0.001). These data indicate that admission to the MICU may result in a beneficial outcome for critically ill patients with BMTs, but for those requiring mechanical ventilation due to respiratory failure, the chances of survival are poor. This information may be useful for providing patients with BMTs and their families with realistic estimates of prognosis prior to transfer to the MICU and mechanical ventilation.
尽管骨髓移植（BMT）后取得了令人鼓舞的结果，但据观察，一旦这些患者病情危急并需要入住医疗重症监护病房（MICU），其存活几率很低。我们推测，虽然机械通气是MICU中死亡的重要预测因素，但那些不需要机械通气的患者可以成功从MICU出院。对36例BMT后入住MICU共43次的患者记录进行了分析。在这些住院病例中，分别有33例（76.7%）患者接受了同种异体移植，10例（23.3%）患者接受了自体移植。总体而言，14例（32.6%）住院患者从MICU顺利出院。接受同种异体或自体移植的患者存活率无显著差异，分别为11例（33.3%）和3例（30.0%）。27例（62.8%）住院患者需要机械通气，其中20例（66.7%）接受同种异体BMT的患者和7例（70.0%）接受自体BMT的患者进行了机械通气，两者无显著差异。在MICU住院期间，需要机械通气的患者存活率显著低于不需要机械通气的患者，分别为1例（3.7%）和13例（81.3%）（p<0.001）。未在MICU存活的患者平均APACHE II评分为21.2±4.7，显著高于存活患者的15.8±3.8（p<0.001）。存活患者的平均住院时间为4.4 + 3.0天，显著短于未存活患者的17.8±24.0天（p<0.001）。这些数据表明，入住MICU可能对重症BMT患者产生有益结果，但对于因呼吸衰竭需要机械通气的患者，存活几率很低。这些信息可能有助于在将患者转入MICU和进行机械通气之前，为接受BMT的患者及其家属提供对预后的实际估计。
