急诊肺炎患者发生急性肺损伤/急性呼吸窘迫综合征危险因素分析

目的探讨急诊肺炎患者发生急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析中国医科大学附属第一医院急诊科收治的100例肺炎患者,其中男性62例,女性38例;年龄49~79岁,平均年龄62岁。观察72h,发展至ALI/ARDS为ALI/ARDS组,未发展至ALI/ARDS的分为单纯肺炎组。收集两组患者的年龄、性别、生命体征、初始所需吸氧浓度及初诊的实验室检查(白细胞、血小板计数、血清白蛋白、尿素氮、丙氨酸氨基转移酶)指标,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类的Logistic回归分析。结果 100例患者35例发展为ALI/ARDS,65例未发展为ALI/ARDS。单因素分析结果显示,患者是否发展为ALI/ARDS与年龄、性别、体温、呼吸频率、休克、白细胞计数、尿素氮等比较,差异无统计学意义(P0.05);初始所需吸氧浓度(维持血氧饱和度≥90%)、改良后的快速急诊内科评分(REMS)、低蛋白血症与发展为ALI/ARDS差异有统计学意义(P0.05)。二项分类的Logistic回归分析显示,仅吸氧浓度、改良后的REMS评分是发展为ALI/ARDS的独立危险因素。其中吸氧浓度2 L/min的灵敏度为77.1%,特异度为86.2%;改良后的REMS≥7发生ALI/ARDS灵敏度为74.3%,特异度为72.3%。结论初始吸氧浓度及改良后的REMS评分与ALI/ARDS的发生存在正相关,初始吸氧浓度2 L/min和/或改良后的REMS≥7的肺炎患者应予以重视,是ALI/ARDS的高危患者,争取做到早期诊治。

Analysis of ALI/ ARDS risk factors in patients with pneumonia in Emergency Department

Objective To discuss the acute lung injury （ALl） / acute respiratory distress syndrome （ARDS） early risk factors in patients with pneumonia in emergency treatment. Methods A total of 100 emergency patients with pneumonia in The First Hospital of China Medical University were enrolled, which included 62 males and 38 females, aged 49 - 79 years old with mean age of 62. After 72-hour observation, they were divided into 2 groups, the ALl / ARDS group and simple pneumonia group without ALI/ ARDS. The age, gender, vital signs and initial oxygen concentration and laboratory results（white blood cell, platelet count, serum albumin, blood urea nitrogen, serum alanine aminotransferase） were collected. The univariate analysis were performed, and statistical significance results were analyzed by Logistic analysis. Results Thirty- five patients had ALI / ARDS, and 65 patients had simple pneumonia. The univariate analysis indicated that the differences of the age, gender, body temperature, respiratory rate, shock, white blood cell count and blood urea nitrogen were not statistically significant （P 〉 0.05） between the ALI/ ARDS group and simple pneumonia group. The difference of oxygen concentration （required for maintaining blood oxygen saturation above 90 %）, modified rapid emergency medicine score（REMS） and ALI/ ARDS with pneumonia were significant（P 〈 0.05）. The initial oxygen requirement above 2 L/min was 77.1% sensitivity and 86.2 % specificity; the modified REMS above 7 was 74.3 % sensitivity and 72.3 % specificity. Conclusion It is demonstrated that oxygen requirement and modified REMS are ALI/ ARDS independent early risk factors with pneumonia. In clinic, patients with pneumonia oxygen requirement 〉 2 L/min and/or modified REMS above 7 should be taken early treatment.