ARDS与多器官衰竭的病原谱和临床特点

报告32例ARDS/MOF患者发生的感染,其中免疫抑制宿主和老年人各占37.5％和43.8％,因感染导致MOF者占75.0％,内由原发性肺炎引起者占全部病例的53.1％;败血症为导致MOF的第二位原因。ARDS/MOF感染病原体中79.3％为条件致病菌,高度耐药的非发酵菌、肠球菌、表皮葡萄球菌尤其常见,占55.9％,特殊病原体占15.2％。有43.8％的患者发生菌群转换,转换频率为3.4。半数以上(17例)出现复合菌,发生复合菌感染者受累衰竭器官数3.8个,而单一感染者平均2.9个。死亡率81.3％,死亡者平均衰竭器官数3.5个,而痊愈者为2.5个,表明ARDS/MOF患者感染越严重,衰竭器官数越多,病死率越高。

Infections in adult respiratory distress syndrome or mltiple organ failure: Etiologic spectrum and clinical character

Thirty two cases of ARDS or MOF with infections are reported. 37. 5% (12 cases) and 43. 8% (14 caese) were of the immunocompromised hosts and the elderly patients, respectively. Of the 32 patients, 24(75. 0%) resulted from primary infections, which included pneumonia (17 cases ), sepsis (5 cases ), and intra - abdominal infections (2 cases ). Opportunists were the predominant microbial isolated, 55. 9% were of nonfermental Gram negative bacilli, S. epidermidis and Entercococcus, 15. 2% were of specfic organisms (AFB, Fungi, Pneumocystis Carinii). 43. 8%(14 cases) of patients occured bacteria alternation,and its frequency was 3. 4; 17 of 32 patients presented mixed bacteria,the mean number of failed organ in mixed bacteria infections patients was 3. 8, and that in single organism infection patients was 2, 9. The overall mortality was 81. 3% (26 of 32 patients) ,the mean number of organ involved was 3. 5 in nonsurvivors and 2. 5 in survivors. Results showed that the extent of infections was greater,the mortality was higher.