Outcome of patients with connective tissue disease requiring intensive care for respiratory failure
Outcome of patients with connective tissue disease requiring intensive care for respiratory failure
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DOI：
10.1007/s00296-011-2158-6
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发表时间：
2012-11-01
影响因子：
4
通讯作者：
Lee, Sang-Min
中科院分区：
文献类型：
--
作者：
Lee, Jinwoo;Yim, Jae-Joon;Lee, Sang-Min
结缔组织病（CTD）患者偶尔会发生急性呼吸衰竭（ARF），但这些患者的ARF病因尚未完全阐明。本研究的目的是找出ARF的原因，导致入住重症监护病房（ICU）的这些患者，并评估其临床结果。回顾了自2005年1月至2008年9月在首尔国立大学医院ICU连续收治的1，870例患者的病历。共分析了66例CTD患者。中位年龄为58岁，45例患者为女性。ICU住院时间的中位数为16天，机械通气支持的中位数为15天。基础CTD的分布为系统性红斑狼疮17例，类风湿性关节炎15例，系统性血管炎14例，多发性肌炎-皮肌炎9例。肺炎是24例患者（36%）ARF的主要原因。我们无法确定14例ARF的原因。ARF的其他原因是9例患者的急性肺水肿，8例弥漫性肺泡出血和4例肺孢子虫肺炎。41例（62%）患者在入院期间死亡，急性肺水肿患者的死亡率最低。去甲肾上腺素的使用在死亡者中统计学上更高。我们可以确定导致至少80% CTD患者入住ICU的ARF原因。然而，无论病因如何，这些患者仍然显示出高死亡率。血流动力学状态可能影响其生存。
Occasionally acute respiratory failure (ARF) develops in patients with connective tissue disease (CTD), but the etiologies of ARF in these patients are not fully elucidated. The objective of this study is to find out the causes of ARF leading to intensive care unit (ICU) admission in these patients and to assess their clinical outcome. The medical records of 1,870 consecutive patients admitted to the ICU in Seoul National University Hospital since January 2005-September 2008 were reviewed. A total of 66 patients with CTD were analyzed. The median age was 58 years, and 45 patients were women. The median length of ICU stay was 16 days with a median duration of mechanical ventilation support of 15 days. The distribution of underlying CTD was 17 patients with systemic lupus erythematosus; 15 with rheumatoid arthritis; 14 with systemic vasculitis; and nine with polymyositis-dermatomyositis. Pneumonia was the leading cause of ARF in 24 patients (36%). We could not identify the cause of ARF in 14. Other causes of ARF were acute pulmonary edema for nine patients, diffuse alveolar hemorrhage for eight and Pneumocystis pneumonia for four. Forty-one patients (62%) died during admission, and the mortality rate was the lowest in those with acute pulmonary edema. Use of norepinephrine was statistically higher in nonsurvivors. We could identify the cause of ARF leading to ICU admission in at least 80% of patients with CTD. However, these patients still showed a high mortality rate regardless of etiology. Their survival might be influenced by hemodynamic status.