急性呼吸窘迫综合征患者的发病及预后因素分析  

Analysis Morbidity and Prognostic Factors for Patients with Acute Respiratory Distress Syndrome

作　　者：苑林[1] 张仁汉[1] 杨运彩[1] 邵丽华[1] 

机构地区：[1]北京市第六医院急诊科,北京100007

出　　处：《中国医药导刊》2007年第5期368-370,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:总结急性呼吸窘迫综合征(ARDS)的发病及预后因素。方法:收集1998年1月至2004年12月6年间急诊科收治的65例患者临床资料,进行回顾性分析。将1998年1月至2001年12月29例患者归入A组,2002年1月至2004年12月36例患者归入B组。比较两组患者的发病率、氧合指数、APACHEⅡ评分、死亡率,并对所有病人进行影响死亡率的因素分析。结果:两组患者的氧合指数、APACHEⅡ评分无明显差别,发病率、死亡率分别为1.7%和3.3%(P<0.05)、65.2%和41.7%(P<0.05);对所有病人进行的影响预后的危险因素进行分析表明,APACHEⅡ≥30分、机械通气时PEEP水平≥10 cmH_2O、及未接受肾上腺皮质激素治疗,为病人预后不良的指标。结论:随着对发病原因及发病机制的不断认识,综合救治方法的不断改进,ARDS患者的死亡率明显下降,但发病事有增高的趋势;选择合适的机械通气参数、及早应用肾上腺皮质激素可能为降低病死率的有效措施。Objective： To summarize the incidence, morbidity and prognostic factors in 65 patients with Acute Respiratory Distress Syndrome （ARDS）. Methods： From January of 1998 to December of 2004, 65 patients diagnosed with ARDS and accepted by emergency department were reviewed, and 29 patients included in A group from 1998 to 2001,36 patients included in group B from 2002 to 2004. Morbility, morbidity, oxygenation index and APACHE Ⅱ grades were compared between two groups. In all 65 cases, risk factors that affect the prognosis were analyzed. Results： Oxygenation index and APACHE Ⅱ grade have no obvious difference between two groups, but mortality have an increase （1.7% vs. 3.3%, P 〈0. 05）, and morbidity have a decrease （65. 2% vs. 41.7%, P 〈0. 05） in B group. Risk factor analysis suggest that APACHE Ⅱ≥30, PEEP≥10 cmH2 O, and without adrenocortical hormone administration are risk factors for poor prognosis. Conclusion： Because of the constant understanding to the pathogenic factors and mechanism and improvement of therapy, the morbidity in ARDS patients has obviously drops, but the morbility has the tendency to increase; It may be effective measure of reducing morbidity to choose suitable mechanical ventilation parameter and to use adrenocortical hormone early.

关 键 词：急性呼吸窘迫综合征 发病率 死亡率 预后 

分 类 号：R563.8[医药卫生—呼吸系统]