急性呼吸窘迫综合征预后的影响因素分析

目的急性呼吸窘迫综合征（ARDS）预后的影响因素分析。方法纳入2009年1月至2012年2月在温州医学院附属第二医院重症医学科就诊的ARDS患者151例，其中死亡49例。对患者年龄、性别、血压、血糖、人体质量指数（BMI）、ARDS分级、急性病生理学和长期健康评价（APACHE）11评分、序贯器官衰竭估计（SOFA）评分、前降钙素原（PCT）、血管活性药物使用等相关因素进行单因素Logistic回归分析，选择有统计学意义的变量进行多因素Logistic回归分析。结果单因素Logistic分析发现，性别、血压、血糖对ARDS患者预后无统计学意义，而年龄、BMI、ARDS分级、APACHEII评分、SOFA评分、PCT、血管活性药物7个指标均影响ARDS患者的预后（P均〈0．05）。多因素logistic回归分析发现，影响ARDS患者预后的危险因素为ARDS分级（OR=6．895，95％CI=1．447～32．860）、年龄（OR=3．633，95％C1=1．333～9．906）APACHEU评分（OR=1．210，95％CI：1．033～1．417）及SOFA评分（O尺=1．676，95％CI=1．253～2．242），而BMI是保护因素（OR=0．379，95％CI：0．168～0．856）。结论ARDS分级、APACHEII评分、SOFA评分及年龄是ARDS患者预后的不利因素，而BMI是保护因素。

Prognostic factors in patients with acute respiratory distress syndrome

Objective To investigate the prognostic factors in patients with acute respiratory distress syndrome （ARDS）. Methods A total of 151 patients with ARDS in the Second Affiliated Hospital of Wenzhou Medical College from January 2009 to February 2012 were enrolled in the study, including 49 deaths. The associated factors included age, gender, blood pressure, blood glucose, body mass index （BMI）, grading of the severity of ARDS, APECHE II score, SOFA score, procalcitonin （PCT）, and vasoactive agents. The related factors of ARDS were evaluated by univariate Logistical regression analysis, and the statistical significant variables were analyzed by multivariate logistical regression analysis. Results Univariate logistical regression analysis showed that the levels of BMI, grading of the severity of ARDS, APECHE II score, SOFA score, PCT, vasoactive agents and age were closely connected with the prognosis of ARDS （all P 〈 0.05）, while no statistical significances were noted in gender, levels of blood pressure and blood glucose. By multivariate logistical regression analysis, grading of the severity of ARDS （OR： 6.895, 95%CI： 1.447 to 32.860）, age （OR： 3.633, 95%C1：1.333 to 9.906）, APECHE II score （OR： 1.210, 95%CI： 1.033 to 1.417） and SOFA score （OR： 1.676, 95%CI： 1.253 to 2.242） were independent risk factors of the prognosis of ARDS, while BMI was the protective factor （OR： 0.379, 95%CI： 0.168 to 0.856）. Conclusion Grading the severity of ARDS, APECHEl] score, SOFA score and age were the high risk factors in ARDS, while BMI was a protective factor.