2004～2009年我院ICU急性呼吸窘迫综合征的发病及死因分析

目的调查晋城煤业集团总医院ICU中急性呼吸窘迫综合征（ARDS）的发病情况、原发病、病死率及其影响因素。方法根据中华医学会重症医学分会急性肺损伤／急性呼吸窘迫综合征诊断和治疗指南（2006）中诊断标准，沿用1994年欧美ARDS联席会议制定的ARDS诊断标准，回顾性调查2004～2009年晋城煤业集团总医院ICU中ARDS患者的原发病、逐年发病情况、病死情况及其影响因素。结果2004年1月至2009年12月年晋城煤业集团总院ICU共收治危重病患者1714例，其中60例符合ARDS诊断标准，占同期ICU收治的各类危重患者的3．5％。肺内疾病致ARDS（肺内型ARDS）共16例，（占26．7％），死亡10例，病死率62．5％。肺外疾病致ARDS（肺外型ARDS）共44例（占73．3％），死亡21例，病死率47．1％。肺内型ARDS病死率明显高于肺外型（X^2=13．261，P〈0．01）。原发病为脓毒症13例（占21．7％）及肺炎10例（占16．7％），其他为大手术、重症胰腺炎（5％）、多发性创伤（25％）等。60例ARDS患者中死亡31例，其中肺内疾病死亡10例（占32．3％），肺外疾病死亡21例（占67．7％）。ARDS总病死率为51．67％。6年间病死率无明显变化。脓毒性休克是主要的死亡原因。结论①6年间ARDS平均发病率为3．5％，2007年最低（2．97％），从2004年（3．17％）到2009年（4．06％），呈缓慢上升趋势；②6年间总病死率达51．67％；肺内型ARDS病死率明显高于肺外型ARDS，6年间病死率无明显变化；③危重病患者并非死于单纯的ARDS；ARDS患者多数死于感染性休克；④发生感染性休克或多脏器功能衰竭（MOF）时，则病死率明显增加。

Analysis of incidence condition and correlation with ARDSin General hospital of Jincheng Coal mining Group Co,Lid

Objective To investigate incidence,cause and mortality of acute respiratory distress syndrom (ARDS) in intensive care unit in Jincheng mineral general hospital.Methods Patients in ICU of Jincheng mineral general hospital from 2004 to 2009 were retrospectively studied.ARDSwas diagnosed according to the 1994 American-European consensus conference criteria.Results Of 1714 patients admitted to ICUs in the same period,there were 60 patients (3.5%) diagnosed as having ARDS.In 16 pulmonary ARDScases (26.7%) ,10 died,mortality was 62.5%.In 44 extro-Pulmonary ARDSpatients (73.3%),21 died,mortality was 47.1%.Pulmonary ARDSmortality was significantly higher than the extro-Pulmonary ARDS(x2 = 13.261 ,P ＜0.01).Major primary diseases for ARDSwere sepsis (21.7%),pneumonia (16.7%) ,multiple severe truma (25%) ,acute pancreatitis (5%).The overall mortality of ARDSwas 51.67%.septic shock (51.61%) was major lethal cause,while only 29.03% died of respiratory failure.In six years,mortality had no significant changes.Conclusion ARDS frequent in ICU in Jincheng,the mortality remains high,and there is no tendency to decline in recent years.