摘要
目的研究ARDS的发病率、致病因素、临床生理特征、病死率及其预测因子。方法对第二军医大学附属长海医院中心ICU在1994年4月～2003年12月间收治的5314例患者中行回顾性分析。符合ARDS诊断的131例，其中115例存活时间超过24h。所有患者在ARDS发生时进行APACHE Ⅲ评分、LIS评分和MODS评分。采集指标包括年龄、性别、血液生化指标、血气分析、ICU滞留时间、机械通气时间、气管切开与否、机械通气相关参数、是否手术以及是否急诊手术。结果131例ARDS患者中有12例符合诊断标准的病例因为在24h内死亡而被排除，4例患者因资料不完整而被剔除。存活时间超过24h且资料较为完整的病例有115例病人，占收治人数的2．2％。115例ARDS患者中，男性62例（53．9％），女性53例（46．1％）。年龄为55．56岁±11．24岁，ICU滞留时间为11．27d±7．24d，APACHEm评分（17．23±7．21）分。主要致病因素为肺部感染和脓毒症。死亡组的MODS评分显著高于生存组，BE值也显著低于生存组。在第一周，生存组和死亡组之间的MODS评分和气道平台压始终区别明显。住院病死率为55．7％。主要死亡原因为MOF。在ARDS发生时，对病死的独立预测因子有高龄、超过8分的MODS评分和超过2．76的LIS评分。结论ARDS是ICU中一种较为常见的综合征，致病因素主要为脓毒症和肺部感染；ARDS病死率较高，死亡原因主要为MOF；年龄、MODS评分和LIS评分可能是ARDS死亡预测的独立因子。
Objective To assess, the incidence, etiology, physiologic and clinical features, mortality and predictors of the acute respiratory distress syndrome（ARDS）. Methods A retrospective analysis of 5 314 patients from Apirl 1994 to December 2003 was performed in ICU of Changhai Hospital. The ARDS patients were identified using the criteria of the American - European Consen- sus Conference （AECC）. Acute Physiology and Chronic Health Evaluation III（APACHE m ） , Multiple Organ Dysfunction Syndrome Score（MODS score） , and Lung Injuy Score（LIS） was determined on the onset day of ARDS for all patients. Other recorded variables were age, sex, biochemical indicator, blood gas analysis, ICU length of stay, length of ventilation, presence or absence of tracheosto- my, ventilation variables, elective versus emergency surgery. Results Totally, 131 patients（2.5% ） developed ARDS, 12 cases of whom died within 24 h, and therefore their data were rejected, another 4 cases were also eliminated thanks to their incomplete information. Thus there were only 115 cases left （nm= 62, 53.9 % ; nf = 53, 46.1% ; ） with average age of 58 years, making up 2.2%of the total admitted patients. Their average ICU stay was （ 11.27 ±7.24） d,and APACHE m score was （ 17.23 ±7.21 ）. Pneumonia and sepsis were the main cause of ARDS. The nonsurvivors are obviously older, and show significant difference in the ICU length of stay, and length of ventilation as compared with the survivors. At admission, nonsurvivors had significantly higher Multiple Organ Dysfuncton Score, and lower BE. Hospital mortality was 55.7%. Main causes of death were multiple organ failure. Predictors of death at the onset of ARDS were advanced age, Multiple Organ Dysfunction Score ≥8, and Lung Injury Score ≥2.76. Conclusion Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis and pneumonia were the most common risk factors. Main causes of death were multiple organ failure. Mortality was high but similar to most recent series that included serious comorbidities. Based on this patient population, advanced age, MODS Score, and LIS may be the important prognostic indicators for ARDS.
出处
《国际麻醉学与复苏杂志》
CAS
2008年第1期1-4,44,共5页
International Journal of Anesthesiology and Resuscitation
