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肿瘤患者并发急性呼吸衰竭病因与诊断策略探讨 被引量:2

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摘要 目的:探讨恶性肿瘤并发急性呼吸衰竭(ARF)的病因以及纤维支气管镜一支气管肺泡灌洗(FO—BAL)与无创检查对病因诊断的比较。方法:选择肿瘤并发ARF需呼吸机支持的患者68例.随机分成早期FO—BAL组(33例)与无创检查组(35例),FO—BAL组24h内除完成血、痰或其他分泌液培养与镜检、血降钙素原、B一型脑钠肽、G试验、GM试验、胸片、cT等无创检查外,还给予FO.BAL:无创组24h内只行无创检查。结果:早期FO.BAL组为39.39%(13/33)的患者提供病因诊断依据;FO—BAL为5例患者提供唯一诊断依据(无创检查阴性):39例即72.72%的患者通过无创检查明确原因。FO—BAL结果对FO.BAL组9例患者的治疗产生了影响,无创结果对无创组11例患者的治疗产生了影响。急性呼吸衰竭病因前3位是细菌感染(42.50%,34/80)、真菌感染(21.25%,17/80)、肿瘤浸润(13.75%,11/80)。粒细胞缺乏仅占7.35%。两组入ICU至急性呼吸衰竭病因确认时间,早期F0一BAL组65h(16—146)h,无创组73h(14—158)h.P=0.086。两组在MV时间、ICU住院时间及28d死亡率均无统计学意义。结论:对于并发急性呼吸衰竭的恶性肿瘤患者在ICU行F0.BAL是安全的,无创检查能为大多数患者提供病因诊断,其诊断价值不劣于F0一BAL:细菌性肺炎、真菌性肺炎、肿瘤浸润是肿瘤患者ARF的前三位原因.肿瘤科医生尤应警惕真菌性肺炎的发生。
出处 《实用医学杂志》 CAS 北大核心 2014年第5期801-804,共4页 The Journal of Practical Medicine
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