Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The 3 years Prognosis of Patients with Long Term Mechanical Ventilation in Medical Intensive Care Unit at a University Hospital

한 대학병원 내과계중환자실에서 장기간 기계 환기를 받은 환자들의 3년 예후

  • Chon, Gyu Rak (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Choi, Ik Su (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Dong-Soon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine)
  • 전규락 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 최익수 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2007.03.09
  • Accepted : 2007.05.04
  • Published : 2007.05.30
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Abstract

Background: There is little data on the 3 year prognosis and quality of life of patients on long-term (>72 hour) mechanical ventilation in a medical intensive care unit (MICU). Methods: Patients with long-term mechanical ventilation from May 2003 through July 2003 in MICU of Asan Medical Center, Seoul were enrolled in this studay. The survival rates were observed prospectively at 1, 3, 6, 12, 24, 36 months, and the quality of life of survivor was measured at 12 months by using Short Form 36 (SF-36). Results: The survival rate at 1, 3, 6, 12, 24 and 36 months was 54.8% (40/73), 39.7% (29/73), 30.1% (22/73), 20.5% (15/73), 18.3% (13/71) and 16.9% (12/71), respectively. There was a similar survival rate regardless of the diseases that required mechanical ventilation. A neoplasm or chronic liver disease had a worse survival rate than chronic lung or kidney disease (p<0.05). Each SF-36 domain except for the Role-emotional was inferior to the general population. Conclusions: The survival rate of patients with mechanical ventilation more than 72 hours is decreases continuously until 12 months but is relatively constant from 12 to 36 months. In these patients quality of life is also decrased.

연구배경: 내과계중환자실에서 72시간 이상 장기간 기계 환기를 받은 환자들의 자료가 부족하여 기저질환별, 기계 환기가 필요했던 원인질환별로 장기 예후를 관찰하며, 또한 1년째에는 삶의 질 평가를 같이 수행하여 이 환자들의 삶의 질 상태를 평가 하고자 하였다. 방 법: 2003년 3월부터 2003년 7월까지 서울아산병원 내과계중환자실에서 72시간 이상 기계 환기치료를 받은 환자 73명을 대상으로 1, 3, 6, 12, 24, 36개월 생존율을 전향적으로 관찰하고 1년 생존자를 대상으로 Short Form 36(SF-36)을 이용하여 삶의 질을 측정하였다. 결 과: 대상 환자들의 1개월 생존율은 54.8%(40/73), 3개월 생존율은 39.7%(29/73), 6개월 생존율은 30.1%(22/73), 12개월 생존율은 20.5%(15/73), 24개월 생존율은 18.3%(13/71), 그리고 36개월 생존율은 16.9%(12/71)이었다. 3년간 생존율은 기계 환기가 필요했던 원인질환별로는 차이가 없었고, 기저질환별로는 신생물 또는 만성간질환이 만성폐질환이나 만성신장질환에 비해 예후가 불량하였다(p<0.05). SF-36을 이용한 삶의 질 평가에서 정상 대조군과 비교 시 정신적 건강영역에서 Role limiting due to emotional problem을 제외하고 모두 낮은 값을 보였다. 결 론: 한 대학병원 내과계중환자실에서 72시간이상 장기간 기계 환기를 받은 환자들의 3년간 생존율은 낮았으며, 12개월까지 지속적으로 낮아지나 12개월부터 36개월까지는 유지되었다. 1년 시점에서 삶의 질 평가 시 이 환자들의 삶의 질 상태가 낮음을 보여주었다.

Keywords

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