166例急性呼吸窘迫综合征肺内和肺外诱发因素临床分析

目的 比较肺内原因诱发的急性呼吸窘迫综合征(acute respiratory distress syndrome of pulmonary origin,ARDSp)和肺外原因诱发的ARDS(ARDS of extra-pulmonary origin,ARDSexp)临床特征的差异.方法 收集我院重症监护病房(ICU)确诊的166例ARDS患者的临床资料,比较肺内原因诱发和肺外原因诱因所致ARDS患者各项临床特征及预后的差异.结果 两组治疗前氧合指数(PaO2/FiO2)差异无统计学意义,机械通气48小时后两组患者PaO2/FiO2均有明显的升高,但肺外组升高的更多,治疗后两组差异有统计学意义(P<0.05);治疗后分别为(147.21±79.31) mmHg vs (191.05±84.60) mmHg.治疗前两组肺内分流比值(QS/QT)差异无统计学意义,治疗后两组QS/QT均有轻微降低,但治疗后两组比较差异无统计学意义.肺内﹑肺外组病死率分别为79.8%(79/99)和64.2%(43/67),两组差异具有统计学意义(P<0.05).ARDSp和ARDSexp常见死因为多器官功能障碍综合征(MODS).肺外组MODS发生率要高于肺内组.多因素分析提示衰竭器官数目≥3是影响预后的独立危险因素(OR=1.771,95%CI=1.466~2.139,P<0.05).结论 ARDS病死率高;ARDSp和ARDSexp在病死率、MODS发生率等方面差异有统计学意义;机械通气48小时后ARDSexp的肺部的氧合改善要比ARDSp明显;衰竭器官数目≥3是影响ARDS预后的独立危险因素.

Clinical analysis on 166 cases with acute respiratory distress syndrome of pulmonary origin and extra-pulmonary origin

Objective To compare the clinical differences between acute respiratory distress syndrome of pulmonary origin（ARDSp） and acute respiratory distress syndrome of extra-pulmonary origin（ARDSexp）.Methods Clinical data of patients with ARDS in the intensive care unit of the hospital were collected,and the patients were divided into ARDSp and ARDSexp groups according to the inducing factors.Results The oxygenation of ARDSexp was improved more significantly than that of ARDSp by ventilation support,post treatment PaO2/FiO2 （147.21±79.31） mmHg vs （191.05±84.60） mmHg（P〈0.05）.There was no significant difference between the two groups on QS/QT（P〉0.05）.The mortality was higher in ARDSp group than in ARDSexp,79.8%（79/99） vs 64.2%（43/67）（P〈0.05）.The incidence of multiple organ dysfunction syndrome（MODS） was higher in ARDSexp than in ARDSp.MODS was the major lethal cause for ARDS.Analysis by multiple logistic regression demonstrated that organ failure number ≥3 was a risk factor for the prognosis （OR=1.771,95%CI=1.466-2.139,P〈0.05）.Conclusion The mortality rate of ARDS is high.There are differences between ARDSp and ARDSexp on mechanical ventilation effect and mortality rate;organ failure number ≥3 is a risk factor for the prognosis.