阳明腑实证合并急性肺损伤/急性呼吸窘迫综合征患者预后因素分析：附206例多中心报告  

An analysis of prognostic factors in patients suffering from acute lung injury/acute respiratory distress syndrome complicated with Yangming Fushi syndrome：a report of 206 cases from multiple centers

作　　者：闫丽娜[1] 傅强[2] 杜超[3] 余杨梓[3] 李静[3] 刘清泉[4] 薛承瑞[5] 齐清会[6] 李建平[7] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市第四中心医院重症科,300140 [3]天津市南开医院重症科,300100 [4]北京中医药大学东直门医院急诊科,100700 [5]天津医科大学总医院中西医结合外科,300052 [6]大连医科大学附属第一医院普通外科,辽宁大连116011 [7]江苏省无锡市第三人民医院肝胆胰中心,江苏无锡214000

出　　处：《中华危重病急救医学》2015年第7期548-551,共4页Chinese Critical Care Medicine

基　　金：国家重点基础研究发展计划（973）项目（2009CB522703）

摘　　要：目的：探讨阳明腑实证合并急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）患者的死亡危险因素。方法采用前瞻性研究方法，选择2009年8月至2013年7月天津市南开医院、北京中医药大学东直门医院、天津医科大学总医院、大连医科大学附属第一医院、江苏省无锡市第三人民医院5家医院入选的符合阳明腑实证表现的腹部疾病合并ALI/ARDS的206例患者，按重症加强治疗病房（ICU）住院期间存活情况分为死亡组和存活组。记录两组患者的性别、年龄，纳入观察后第一个24 h急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、有创机械通气时间、血管活性药物使用情况、手术比例、ICU住院时间、是否应用连续性肾脏替代治疗（CRRT）、输血比例、C-反应蛋白（CRP）、乳酸/甘露醇（L/M）比值、累及器官数、氧合指数（PaO2/FiO2）、乳酸及血肌酐（SCr）水平；采用logistic回归分析筛选患者死亡的独立危险因素。结果阳明腑实证合并ALI/ARDS患者的原发病主要为重症急性胰腺炎（SAP）124例，占60.19%；ICU住院期间存活171例，死亡35例，病死率为16.99%。对两组患者的各项危险因素进行单因素分析显示，与存活组比较，死亡组患者的年龄大（岁：57.26±16.23比48.07±13.48，t＝3.544，P＝0.000），APACHEⅡ评分高（分：20.83±9.73比12.61±6.63，t＝4.777，P＝0.000），机械通气时间长（d：10.97±7.71比6.91±2.48，t＝2.555， P＝0.015），累及器官多（个：3.11±1.21比1.60±1.34，t＝6.222，P＝0.000），PaO2/FiO2低〔mmHg（1 mmHg＝0.133 kPa）：218.56±64.90比244.58±85.10，t＝-2.024，P＝0.044〕，ICU住院时间长（d：14.33±10.81比9.11±7.37，t＝2.600，P＝0.010），CRRT使用率高〔28.57%（10/35）比15.20%（26/171），χ2＝3.968，P＝0.046〕、血管活性药物使用率高〔28.57%（10/35）比12.28%（21/171），χ2＝6.511，P＝0.011〕，输血比例大ObjectiveTo investigate the risk factors of patients with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） complicated with Yangming Fushi syndrome.Methods A prospective study was conducted. From August 2009 to July 2013, 206 patients with Yangming Fushi syndrome combined with ALI/ARDS were enrolled in the intensive care units （ ICUs ） of the following five hospitals： Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People＇s Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy （ CRRT ）, amount of blood transfusion, the level of C-reactive protein （ CRP ）, lactulose/mannitol （ L/M ） ratio, the number of organs with dysfunction, oxygenation index （ PaO2/FiO2 ）, levels of lactate and serum creatinine （ SCr ） of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients. Results There were 124 cases with severe acute pancreatitis （ SAP ）, which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU, 171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age （ years： 57.26±16.23 vs. 48.07±13.48, t = 3.544, P = 0.000 ）, APACHE Ⅱ score �

关 键 词：阳明腑实证 急性肺损伤 急性呼吸窘迫综合征 流行病学 危险因素 病情严重程度 氧合指数 

分 类 号：R563.8[医药卫生—呼吸系统]