Survival analysis on the critical patients underwent bronchoalveolar lavage
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摘要:
目的探讨支气管肺泡灌洗术(BAL)治疗危重患者的生存期差异。 方法收集重症监护室149例使用呼吸机辅助呼吸的重症患者作为观察对象，分为BAL组及未使用BAL的对照组，对患者进行2年的随访，使用Kaplan-Meier法比较两组的生存期差异。 结果治疗后两组的APACHE II及简化急性生理评分II评分均明显下降，且均以BAL组上述两项评分显著低于对照组（P < 0.05）。两组分别有5例及7例患者治疗1周内死亡，分别占6.94%及9.10%，第1周病死率无统计学差异（χ2=0.168，P=0.682）。BAL组最长生存期的患者大于124周，且该例患者删失；而对照组最长生存期为104周；BAL组的生存期的算术均数及中位数分别为43.5、30.0周，而对照组分别为33.2、25.0周，Kaplan-Meier生存分析显示BAL组的生存期显著长于对照组（χ2=4.419，P=0.036）。 结论尽管使用与不使用BAL短期内对患者的生存率无明显差异，但使用BAL治疗的患者的生存期显著长于不使用BAL者，提示BAL可改善危重患者的远期预后。 Abstract:ObjectiveTo explore the difference of survival time between patients with severe and severe patients treated with bronchoalveolar lavage (BAL). MethodsA total of 149 critical patients who received mechanical ventilator were enrolled and divided into the BAL and non-BAL groups. We performed 2 years followed-up and compared the survival times of 2 groups through Kaplan-Meier analysis. ResultsThe APACHE II and the acute physiology score II declined significantly after treatment for 2 groups. APACHE II as well SAPS II in the BAL group were significantly lower than those in the non-BAL group. There were 5 (6.94%) and 7 (9.10%) patients died during the first week, but the difference of mortality between the two groups was not significant (χ2=0.168, P=0.682). The longest survival time in BAL group was 124 weeks and the patient was censored, but the longest survival time in the non-BAL group was just 104 weeks. The arithmetic mean and median of survival times in BAL group were 33.2 and 25.0 weeks, respectively. Kaplan-Meier analysis showed that the survival times in the BAL group were apparently longer than those in the non-BAL group (χ2=4.419, P=0.036). ConclusionAlthough there is no significant difference of survival rate between the BAL and non-BAL group, patients in the BAL group have significantly longer survival times than those in the non-BAL group. Our study indicates that BAL can improve the prognosis for the critical patients who received mechanical ventilator. -
Key words:
- bronchoalveolar lavage /
- APACHE score /
- SAPS scores /
- survival analysis
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表 1 两组患者一般情况及评分比较(x±s)
分组 n 性别 年龄（岁） APACHE Ⅱ评分 SAPS Ⅱ评分 男 女 治疗前 治疗72 h 治疗前 治疗72 h BAL组 72 43 29 58.29±18.03 20.43±6.79 15.32±4.21* 41.56±13.72 34.67±9.17* 对照组 77 46 31 60.52±19.17 19.57±6.54 17.01±6.14* 40.91±14.05 38.49±11.36* χ2 0.168 -2.892 2.335 -3.826 3.025 -4.192 P 0.682 0.079 0.083 0.038 0.069 0.029 *P < 0.05 vs治疗前. 
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表 2 两组患者生存期均数及中位数比较
分组 n 最长存活期（周） 生存期的算术均数（周） 生存期的中位数（周） 均数 标准误 95%可信区间 均数 标准误 95%可信区间 下限 上限 下限 上限 BAL组 72 124+ 43.468 6.896 29.952 56.984 30 5.382 19.451 40.549 对照组 77 104 33.246 4.654 17.125 35.368 25 6.666 1.935 28.065
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