肾上腺皮质功能状态与急性呼吸窘迫综合征患者预后关系的研究  

Relationship between the adrenal function and the prognosis of acute respiratory distress syndrome

作　　者：杨毅[1] 刘玲[1] 赵波[1] 李茂琴[2] 吴彬[3] 严正[4] 顾勤[5] 孙华[6] 邱海波[1] 

机构地区：[1]东南大学附属中大医院危重病医学科,南京210009 [2]东南大学附属徐州第四人民医院ICU [3]东南大学附属蚌埠市第三人民医院ICU [4]江苏省无锡市第一人民医院ICU [5]南京大学附属鼓楼医院 [6]南通医学院附属南通市第一医院ICU

出　　处：《中华外科杂志》2006年第17期1212-1215,共4页Chinese Journal of Surgery

基　　金：教育部新世纪优秀人才支持基金(NECT-04-0476);江苏省六大人才高峰基金(1190000009);江苏省135重点人才基金

摘　　要：目的探讨肾上腺皮质功能状态与急性呼吸窘迫综合征(ARDS)患者预后的关系。方法纳入2004年7月至2005年2月符合ARDS诊断标准的患者158例,以是否存活分为存活组和死亡组。静脉注射促肾上腺皮质激素250μg,放射免疫分析法测定注射前、注射后30 min及60 min血浆皮质醇水平(T0、T30及T60)。计算T30或T60的最大值与T0的差值(ΔTmax),以ΔTmax≤248．4 nmol／L作为相对肾上腺皮质功能不全的诊断标准。记录患者一般情况、急性生理和慢性健康(APACHEⅡ)评分、心率、呼吸、平均动脉压、氧合指数、动脉血pH、动脉血乳酸、血红蛋白、血小板和白细胞计数、功能衰竭器官个数和住院28 d病死率。结果158例患者中存活72例,死亡86例,28 d住院病死率为54．4％(86／158),相对肾上腺皮质功能不全发生率为42．7％(68／158)。死亡组患者相对肾上腺皮质功能不全发生率明显高于存活组(62．8％vs19．4％,P<0．01)。伴相对肾上腺皮质功能不全的ARDS患者病死率明显升高(76．5％vs36．8％,P<0．01)。ΔTmax判断预后的受试者操作曲线(ROC)下面积为0．655。Logistic多元回归分析显示功能衰竭器官数和相对肾上腺皮质功能不全是ARDS患者死亡的独立危险因素。结论肾上腺皮质功能状态对ARDS患者预后判断有指导价值。Objective To explore the relationship between the adrenal function and the prognosis of acute respiratory distress syndrome （ARDS）. Methods One hundred and fifty-eight patients with ARDS were enrolled in this study and were divided into two groups based on the prognosis ： survival group and death group. Every patient was given one shot of corticotrophin 250 μg intravenously, plasma contisol level was detected by radio-immunoassay before the shot （T0） and 30 minutes （330） and 60 minutes （T60） after. And meanwhile the following parameters in the patients were recorded： age, APACH Ⅱ , heart rate, mean arterial pressure, PaO2/FiO2, arterial pH, hemoglobin, platelets and WBC, the number of failed organ and 28-day mortality. Relative adrenal insufficiency was defined as the difference between TO and the highest value of 330 or T60 （ATmax） ≤248.4 nmol/L. Results The total 28-day mortality was 54.4% （86/158） and the total incidence of relative adrenal insufficiency was 42. 7% （ 68/158 ）. The incidence of relative adrenal insufficiency in death group was significantly higher than that in survival group （62. 8% vsl9. 4%, P 〈0. 01 ）. The 28-day mortality in patients complicated with relative adrenal insuffieienecy was significantly higher than that in those did not （76. 5% vs36. 8% , P〈0. 001）. The area under the ROC curve for ATmax was 0. 655. With the multivariate analysis, the number of failed organ and relative adrenal insufficiency were independent risk factors of the death in patients with ARDS. Conclusions Adrenal function is valuable in predicting the prognosis of the ARDS.

关 键 词：肾上腺皮质功能不全 呼吸窘迫综合征 预后 

分 类 号：R563.8[医药卫生—呼吸系统]