肺内外诱发因素对急性呼吸窘迫综合征预后影响的综合分析  

Influence of pulmonary and extra-pulmonary factors on prognosis of acute respiratory distress syndrome

作　　者：宋志芳[1] 郭晓红[1] 王树云[1] 谢伟[1] 单慧敏[1] 殷娜[1] 张悦[1] 陈列彬[1] 李文华[1] 谢伟霖[1] 

机构地区：[1]上海第二医科大学附属新华医院成人ICU,200092

出　　处：《上海医学》2004年第9期642-645,共4页Shanghai Medical Journal

基　　金：上海市卫生局科技发展基金资助项目 ( 0 0 40 9)

摘　　要：目的　了解肺内、肺外诱因对急性呼吸窘迫综合征 (ARDS)预后的影响。方法　收集我院重症监护病房 2 0 0 0年 5月～ 2 0 0 1年 12月收治的 4 4例ARDS患者临床资料 ,比较肺内、外诱因所致ARDS患者各项临床特征及预后的差异。结果　本组 4 4例患者中 ,肺内组 15例 ,男 4例 ,女 11例 ,平均年龄为 (5 9.0± 18.5 )岁 ;肺外组 2 9例 ,男 14例 ,女 15例 ,平均年龄为 (5 2 .7± 2 1.9)岁 ;两组患者年龄、性别、基础疾病、营养状况、氧合指数 (氧分压 /氧浓度 )、肺内分流值、急性生理功能与慢性健康状况评分Ⅱ、呼气末正压水平、接受机械通气治疗时间、合并感染性休克和 (或 )多脏器功能不全 (MODS)等的差异无显著性 (P >0 .0 5 ) ;肺外组机械通气治疗后氧合状况改善较肺内组明显 (P <0 .0 5 ) ;肺内、外组感染病原菌不明确或混合感染发生率的差异无显著性 (P >0 .0 5 ) ,肺内组的抗菌疗效低于肺外组 (P <0 .0 5 ) ;肺内组病死率 (93.3% )高于肺外组 (4 4 .8% ,P <0 .0 1)。结论　肺内因素所致ARDS患者病死率明显高于肺外组 。Objective The influence of pulmonary and extra-pulmonary factors on the prognosis of acute respiratory distress syndrome (ARDS) were analyzed.Methods Clinical data of patients with ARDS in ICU of our hospital from March 2000 to December 2001 were collected, and they were divided into pulmonary (ARDS P) and extra-pulmonary (ARDS EXP-) groups according to the inducing factors. The significances on the prognosis were evaluated by t-test and χ 2.Results There were 15 cases with ARDS P and 29 with ARDS EXP- including male/female 4/11 and 14/15, age ( 59.0- ±18.5-) and ( 52.7- ±21.9-) years old, respectively. There were no significant differences between the two groups on the following items as age, underlying diseases, nutritional condition, PaO 2/FiO 2, Q S/Q T, APACHE-Ⅱ score, PEEP level, time of ventilation support, septic shock and multiple organic dysfunction syndrome (MODS, P >0.05-).The oxygenation of ARDS EXP- was improved more significantly than ARDS P by ventilation support (P <0.05-). Also, there were no significant differences on the incidence of indefinite pathogen and mixed infection between the two groups (P >0.05-) but the antibiotic effect in ARDS P was lower than that in ARDS EXP- (P <0.05-). The mortality rate was higher in ARDS P group than that in ARDS EXP- ( 93.3%- vs 44.8%-, P< 0.01-).Conclusion The mortality rate in ARDS P is significant higher than that in ARDS EXP- due to the uncontrollable pulmonary infection.

关 键 词：患者 ARDS 急性呼吸窘迫综合征 预后 机械通气治疗 诱发因素 病死率 感染病 显著性 水平 

分 类 号：R563.8[医药卫生—呼吸系统]