急性呼吸窘迫综合征病死危险因素分析

目的　探讨急性呼吸窘迫综合征 (ARDS)病死率居高不下因素。方法　收集 1998— 2 0 0 3年间因ARDS收入 ICU所有患者的临床资料 ,分析各种特定危险因素与病死率之间关系 ,进行 χ2 检验。结果　 30例中 ,年龄 16～ 72岁 ;肺内组病死率 92 % (11/12 ) ,肺外组 4 5 % (8/18) ,肺内组高于肺外组 (P<0 .0 1) ,APACHE 评分≤ 2 0分组病死率低于≥ 31分组 (P<0 .0 5 ) ;呼气末正压 (PEEP)水平 6～ 10 cm H2 O组病死率低于≥ 11cmH2 O组 ;机械通气治疗组病死率明显低于未接受机械通气治疗组 (P<0 .0 1) ;2 3例接受不同类型激素治疗病死率(70 % )高于未接受激素治疗组 (2 9% ) ,差异有显著性 (P<0 .0 1) ,应用时间与剂量间差异无显著性 (P>0 .0 5 ) ;直接死亡原因为 ARDS未得到纠正者仅占 11% (2 /19)。结论　在及时应用机械通气治疗前提下 ,肺内疾病和 A-PACHE 评分≥ 31分可能是预报 ARDS病死率高的指标。

Risk factor analysis on the dead cases of acute respiratory distress syndrome

Objective To probe into the reason why the mortality of acute respiratory distress syndrome (ARDS) is hard to reduce to a some lower level.Methods ARDS patients admitted in the intensive care unit (ICU) during the period of 1998-2003 were listed in this study with their clinical data,to analyse various special risk factors contributing to the death rate,using χ2 test to check the significant difference.Results Thirty dead cases,mortality of 92% (11/12) belonged to the intrapulmonary infection group,that of 45% (8/18) belonged to the extrapulmonary infection group,the former was higher than the latter (P<0.01).According to Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ),the group scoring≤20 had a lower death rate than the group scoring≥31 did (P<0.05);the group with a positive end-expiratory pressure (PEEP) 6～10 cm H 2O had a lower death rate than the group with a PEEP≥11 cm H 2O;the ventilation group′s death rate was remarkably lower than the non-ventilation group′s (P<0.01).Twenty-three cases who had received various corticosteroid therapies got a higher death rate (70%) than those who did not receive any corticosteroid (death rate 29%),P<0.01;no significant difference existed between the medication time and the dosage (P>0.05);there were only 11% (2/19) of the dead cases whose direct death cause was that their ARDS could not be corrected.Conclusion On the premise of timely ventilation therapy the patients′ intrapulmonary disease and their APACHE Ⅱ≥31 might contribute to the high death rate of ARDS.