急性呼吸窘迫综合征预后的影响因素探讨

目的探讨影响急性呼吸窘迫综合征(ARDS)预后的因素。方法对我院呼吸内科重症监护室(R ICU)30例ARDS患者性别、年龄、基础疾病、诱发因素(肺源性、肺外源性)、合并下呼吸道感染、行机械通气、并发多器官功能障碍综合征(MODS)、发病至确诊时间、APACHEⅡ评分、氧合指数(PaO2/F iO2)、C-反应蛋白(CRP)、血清白蛋白(ALB)、血尿素氮(BUN)等因素与其预后的关系行单因素分析。将单因素分析有显著性意义的变量分级并赋值,采用多因素Logistic回归筛选预后因素。结果 30例ARDS患者死亡20例,存活10例。患者的病死率与性别、年龄、诱发因素、合并下呼吸道感染、行机械通气无关。死亡组与存活组患者的APACHEⅡ评分、PaO2/F iO2、CRP、ALB基础值(治疗前)比较差异均无显著性(P>0.05)。既往患基础病、并发MODS、发病至确诊时间长、CRP升高及确诊时BUN指标异常是ARDS患者死亡的独立危险因素。结论既往患基础疾病、并发MODS、发病至确诊时间长、CRP升高与ARDS患者死亡密切相关。

Research on influencing factors of prognoses of acute respiratory distress syndrome(ARDS)

Objective To discuss the influencing factors of prognoses of acute respiratory distress syndrome(ARDS) Methods Analysis on 30 cases of ARDS patients who were admitted in the Department of Respiratory Intensive Care Unit(RICU) by using gender,age,the basis of disease,induced factors(pulmonary and extra-pulmonary),the accompanied lower respiratory tract infection,invasive/non-invasive mechanical ventilation with multiple organ dysfunction syndrome(MODS),Time to disease diagnosis,APACHE Ⅱ score,the oxygenation index(PaO2/FiO2),C-reactive protein(CRP),serum albumin(ALB),blood urea nitrogen(BUN).The analyzed single risk factor which is a significant variable was graded and assigned.Results 20 of 30 cases of ARDS patients died,10 cases survived.There are no significant difference(P> 0.05) between the death group and survival group in APACHE Ⅱ score,PaO2/FiO2,CRP,ALB base value(before treatment).The mortality significantly increased in patients with basal disease,MODS,long duration between disease onset and diagnosis,elevated CRP level,abnormal BUN value when diagnosed.Conclusion In previous time,basic diseases,concurrent MODS,long duration of onset to diagnosis,and elevated CRP level were critical factors of mortality in ARDS patients.