52例中度急性呼吸窘迫综合征患者临床分析  

Clinical analysis of 52 patients with moderate acute respiratory distress syndrome

作　　者：王红军[1] 于洪涛[1] 贾金广 陈琼[2] 臧金萍[1] 卢滨[1] 

机构地区：[1]郑州人民医院呼吸与危重症医学科,河南郑州450000 [2]中南大学湘雅医院干部医疗科,湖南长沙410008

出　　处：《中国现代医学杂志》2014年第27期63-68,共6页China Journal of Modern Medicine

摘　　要：目的探讨不同病原微生物感染所致急性呼吸窘迫综合征临床特征、实验室资料及预后差异。方法回顾性分析2008年1月-2013年6月郑州人民医院RICU收治的52例中度急性呼吸窘迫综合征患者的临床资料,根据致病微生物不同,将上述患者分为2009甲型H1N1流感组和非H1N1流感组,收集两组患者的年龄、基础疾病状况、确诊急性呼吸窘迫综合征后24 h内APACHEⅡ评分、血白细胞总数、动脉血乳酸水平、肌酸激酶、乳酸脱氢酶、D-二聚体定量、超敏C-反应蛋白、降钙素原、对肺复张措施的反应等资料,并比较确诊急性呼吸窘迫综合征4周时两组患者的死亡率。结果 2009甲型H1N1流感组患者年龄、APACHEⅡ评分、血白细胞计数、超敏C-反应蛋白、降钙素原水平均低于非H1N1流感组,其差异有显著性(P值均<0.05);肌酸激酶、乳酸脱氢酶、D-二聚体定量偏高,其差异具有显著性(P值均<0.001);而两组患者血乳酸水平差异无显著性(P>0.50);肺复张措施治疗后30 min,2009甲型H1N1流感组患者的氧合指数及肺静态顺应性均较复张前改善,其差异具有显著性(t值分别为7.26、6.80,P值均<0.01),非H1N1流感组患者的上述指标亦上升(t值分别为8.81、5.78,P值均<0.01),但甲型H1N1流感组患者改善更明显,其差异有显著性(t值分别为5.77、5.26,P值均<0.01);两组患者的气道平台压均有上升趋势,但差异无显著性(P值均>0.05);肺复张时、复张后5 min,两组患者的心率较复张前上升、平均动脉压较复张前下降,其差异有显著性(P值均<0.05),复张后20min,上述指标基本恢复至复张前水平(P值均>0.05)。两组患者气压伤的发生率较低,分别为2/16(12.5%)、5/36(13.8%),其差异无显著性(χ2=0.02,P>0.05);2009甲型H1N1流感组患者死亡率低于非H1N1流感组,其差异有显著性(P<0.005)。Logistic回归分析显示年龄(≥66岁)、具有较严重的基础疾病(尤其是同时患有慢性阻塞性肺�【Objective】To explore the difference among the clinical features, laboratory data and prognosis in patients with acute respiratory distress syndrome led by different pathogen.【Methods】A retrospective study was performed on the clinical data of 52 patients with moderate acute respiratory distress syndrome who were admitted to RICU of people＇s hospital of Zhengzhou from January 2008 to June 2013. The patients were divided into 2009 in-fluenza A（H1N1） group and non-H1N1 influenza group by the pathogen. After confirmed ARDS, the data of all the patients＇ age, underlying diseases and APACHEⅡ value,oxygenation index, the white blood cell count, the concentration of lactate in artery, the concentration of serum creatine kinase, lactate dehydrogenase, D-dimmer, hypersensitive C-reactive protein and procalcitionin within 24 hours were collected. The reactions of all the patients to recruitment maneuvers were collected, too. When patients were confirmed as ARDS 4 weeks later, the mortality of the patients in the two groups was compared.【Results】The age, APACHEⅡ value, white blood cell count and the concentration of serum hypersensitive C-reactive protein and procalcitionin of patients in 2009 influenza A（H1N1）group were lower than those in the non-H1N1 influenza group and the difference was significantly in statistics（P〈0.05）. The concentration of serum creatine kinase, lactate dehydrogenase and D-dimmer of patients in 2009 influenza A（H1N1） group were higher than those in the non-H1N1 influenza group and the difference was significantly in statistics（P〈0.001）. There was no statistical difference between the two groups about the concentration of lactate in artery and oxygenation index（P〉0.05）. The patients in the Non-H1N1 influenza group often had more severely underlying diseases than those in 2009 influenza A（H1N1） group. After the recruitment maneuvers were taken thirty minutes later, the oxygenation index and lung static compliance of the patients in the two groups

关 键 词：急性呼吸窘迫综合征 危重型甲型H1N1流感 机械通气、预后 

分 类 号：R563.8[医药卫生—呼吸系统]