71例急性呼吸窘迫综合征的预后指标分析  

Analysis on prognostic indicators of acute respiratory distress syndrome:a report of 71 cases

作　　者：帅维正[1] 李琦[1] 王长征[1] 钱桂生[1] 何坤霖[2] 扬楠[3] 

机构地区：[1]第三军医大学新桥医院全军呼吸内科研究所,重庆400037 [2]第三军医大学统计学教研室 [3]解放军第316医院门诊部

出　　处：《解放军医学杂志》2009年第4期377-380,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金资助项目(30770928);军队“十一五”攻关课题(06G083);重庆市自然科学基金资助项目(2007BB5072);第三军医大学科研基金资助项目(2006HG04)

摘　　要：目的通过分析急性呼吸窘迫综合征(ARDS)患者高病死率的影响因素,筛选其临床预后指标。方法收集呼吸重症监护室(RICU)2001年6月-2008年5月收治的ARDS患者的临床资料,包括性别,年龄,慢性疾病史,免疫抑制药物使用情况,诱因,确诊24h内各种化验指标(血常规、血气分析、肾功能、血电解质等)的最差值,治疗方法(保护性肺通气策略、预防性抗真菌治疗、早期糖皮质激素冲击治疗、无创通气、持续肾脏替代治疗),急性病理生理学和长期健康评价(APACHE)Ⅱ评分,肺外衰竭器官以及确诊后21d病死率。采用单因素及多因素logistic回归分析各种因素与病死率之间的关系。结果纳入病例71例,男50例,女21例,年龄18～80(45.3±16.0)岁;到确诊后21d为止,死亡42例,死亡率59.2%。联合使用免疫抑制药物(≥3种)患者死亡率为25%(2/8),低于其他未联用免疫抑制药物的患者;病死组患者PaCO2、APACHEⅡ评分(分别为36.5±11.5mmHg、21.7±6.9分)高于存活组(分别为30.0±6.5mmHg、16.7±5.4分,P<0.05)。氧合指数(PaO2/FiO2)≤150mmHg的ARDS患者死亡率为72%(36/50),高于PaO2/FiO2>150mmHg的患者(28.5%,6/21;P<0.05)。经单因素logistic回归分析,免疫抑制药物≥3种、PaCO2≥50mmHg、PaO2/FiO2≤150mmHg、APACHEⅡ≥18分、PaO2/FiO2≤150mmHg+APACHEⅡ≥18分等因素与ARDS病死率相关。在此基础上进行多因素logistic回归分析,提示PaO2/FiO2≤150mmHg+APACHEⅡ≥18分是ARDS患者预后不良的独立危险因素。结论在对ARDS患者进行以治疗原发病为主的综合治疗的前提下,PaO2/FiO2≤150mmHg+APACHEⅡ≥18分可以作为评价ARDS患者预后的指标。Objective To determine the prognostic indicators of acute respiratory distress syndrome （ARDS） by comprehensive anal ysis of the mortality risk factors for ARDS. Methods The clinical data of 71 patients with ARDS from June 2001 to May 2008 were collected and analyzed, including gender, age, case history of chronic diseases, use of immunosuppressive drugs, predisposing factors, the worst values of laboratory examinations within 24 hours of diagnosis （including routine blood tests, blood gas analysis, renal function, blood electrolytes）, therapies （including protective ventilation, prophylactic anti-ftmgal infection, corticosteroids stosstherapy, non-invasive ventilation, continuous renal replacement therapy）, Acute Physiology and Chronic Health Evaluation （APACHE）Ⅱ scores, failure of or gans other than lung, and mortality within 21d of final diagnosis. Multiple logistic and univariate regression analyses were performed to assess the association between the factors listed above and the mortality. Results Of the 71 cases analyzed, 50 cases were males and 21 females, age ranged from 18 to 60 years （mean age 45. 26±16. 00 years）. The overall mortality was 59.2% （42/71） within 21d of final diagnosis. The mortality of patients to whom more than 3 kinds of immunosuppressive drugs had been given, was 25% （2/8）, and it was lower than that of the patients who were given no immunosuppressive drugs. The PaCO2 and APACHE Ⅱ scores of the non-survivors （36. 5±11.5mmHg and 21.7±6. 9） were higher than that of the survivors （30. 0±6. 5mrnHg and 16. 7±5. 4,P〈0. 05）. The mortality of the pa tients with low oxygenation index （≤150mmHg） was 72% （36/50）, which was higher than that of the patients with high oxygenation index （〉150） （28. 5%, P〈0.05）. Univariate regression analysis indicated that the case fatality of patients with ARDS was associated with the factors as follows： usage of more than 3 kinds of immunosuppresive drugs, PaCO2≥50mmHg, PaO2/FiO2≤150mmHg, A

关 键 词：急性呼吸窘迫综合征 成人 预后 回顾性分析 急性病理生理学和长期健康评价 氧合指数 

分 类 号：R563.9[医药卫生—呼吸系统]