急性呼吸窘迫综合征的预后指标分析(1)
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中图分类号:R563.8
文献标识码: A
文章编号: 1672-3783(2009)-08-0011-04
【摘 要】目的 通过分析急性呼吸窘迫综合征(ARDS)患者高病死率的影响因素,筛选其临床预后指标。方法 收集我院急诊科2005年6月～2008年6月收治的ARDS患者60例的临床资料。包括确诊24 h内各种化验指标的值,治疗方法,急性病理生理学和长期健康评价(APACHE)Ⅱ评分,肺外衰竭器官以及确诊后14 d病死率。采用单因素及多因素logistic回归分析各种因素与病死率之间的关系。结果 到确诊后14 d为止,死亡35例,死亡率58.3%。联合使用免疫抑制药物(≥3种)患者的死亡率高于其他未联用免疫抑制药物的患者;病死组患者PaCO2、APACHEⅡ评分高于存活组。氧合指数(PaO2/FiO2)≤150mmHg的ARDS患者死亡率,高于PaO2/FiO2>150mmHg的患者 。经单因素logistic回归分析,免疫抑制药物≥3种、PaCO2≥50mmHg、PaO2/FiO2≤150mmHg、APACHEⅡ≥18分等因素与ARDS病死率相关。在此基础上进行多因素logistic回归分析,提示PaO2/FiO2≤150mmHg+APACHEⅡ≥18分是ARDS患者预后不良的独立危险因素。结论 在对ARDS患者进行以治疗原发病为主的综合治疗的前提下,PaO2/FiO2≤150mmHg+APACHEⅡ≥18分可以作为评价ARDS患者预后的指标。
【关键词】急性呼吸窘迫综合征 ;预后;氧合指数
Analysis on Prognostic Indicators of Acute Respiratory Distress Syndrome
ZHAO Jin-rong
The First People’s Hospital of Shuangliu,Shuangliu 610200,China
【Abstract】ObjectiveTo determine the prognostic indicators of acute respiratory distress syndrome (ARDS) by comprehensive analis of the mortality risk factors for ARDS.Methods The clinical data of 60 cases withARDS from June 2005 to June 2008 were collected and analyzed, including the values of laboratory examinations within 24 hours of diagnosis, therapies, Acute Physiology and Chronic Health Evaluation (APACHE)Ⅱscores, failure of organns other than lung, and mortality within 14 d of final diagnosis.Multiple logistic and univariate regression analyses were performed to asess the association between the factors listed above and the mortality.Results The overall mortality was 58.3% within 14of final diagsis.The mortality of patients to whom more than 3 kinds of immunosuppressive drugs had been given, was lower than that of the patients who were given no immunosuppressive drugs.The PaCO2 and APACHEⅡscores of the non-survivorswere higher than that of the survivors .The mortality of the patients with low oxygenation index (≤150mmHg) was higher than that of the patients with high oxygenation index(≥150).Univariate regression analysis indicated that the case fatality of patients with ARDS was associated with factors as follows: usage of more than 3 kinds of immunosuppresive drugs, PaCO2≥50mmHg, PaO2/FiO2≤150mmHg, APACHEⅡscore≥18 ......
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