摘要
目的探讨脓毒症患者从发病到入院6h内并发急性呼吸窘迫综合征(ARDS)的早期危险因素以及早期液体管理的重要性。方法回顾149例脓毒症患者的临床特点,采用单因素分析以及多因素logistic回归分析寻找与ARDS早期进展有关的危险因素。结果 31例患者(20.8%)入院后发生ARDS,25例(16.8%)发生脓毒性休克。在单因素分析中,APACHE II评分、6h内液体入量、住院时间、有无脓毒性休克、肺部感染、胰腺炎、输血制品、急腹症、呼吸急促(HR>30次/min)、低氧血症(SpO_2<95%)、低蛋白血症和FiO_2>0.35两组间的差异均有统计学意义(均P<0.05)。多因素分析中APACHE II评分(OR=1.10,95%CI:1.07~1.13)、入院6h内总液体入量(OR=1.15,95%CI:1.03~1.29)、脓毒症休克(OR=2.57,95%CI:1.62~4.08)、肺部感染(OR=2.31,95%CI:1.59~3.36)、胰腺炎(OR=3.86,95%CI:1.33~11.24)、急腹症(OR=3.77,95%CI:1.37~10.41)和呼吸急促(OR=1.41,95%CI:1.00~1.97)为发生ARDS的独立危险因素。结论脓毒症患者早期出现ARDS的独立危险因素在不伴有脓毒性休克的患者中为APACHE II评分、休克、肺源感染、胰腺炎和急腹症等,而在伴有脓毒性休克的患者中主要为液体出入量。
Objective To assess the risk factors of acute respiratory distress syndrome （ARDS） in septic patients. Methods One hundred and forty nine patients with sepsis admitted in emergency department of our hospital from April 2013 to April 2017 were enrolled. Univariate and multivariate logistic regression analyses were performed to assess the risk factors associated with early development of ARDS. Results Among 149 patients ARDS developed in 31 cases （20.8%） after admission and septic shock developed in 25 cases （16.8%）. Univariate analysis showed that the occurence of ARDS was significantly associated with APACHE II score, volume of fluid intake within 6h, length of hospital stay, septic shock, pulmonary infection, pancreatitis, blood transfusion, acute abdomen, tachypnea （HR 〉30/min）, low oxygenemia （Sp〇 2〈95%）, hypoproteinemia and Fi〇2 〉 0.35 （P〈0.05）. Multivariate analysis showed that APACHE II score（OR=1.10, 95%C7： 1.07-1.13） , total fluid intake （L） within 6h of admission （OR=1.15, 95%C7： 1.03-1.29） , septic shock（OR=2.57, 95%C7：1.62-4.08）, pulmonary infection（OR=2.31, 95%C7： 1.59-3.36）, pancreatitis （OR=3.86, 95%C7：1.33-11.24）, acute abdomen （OR=3.77, 95%C7： 1.37-10.41） and tachypnea （OR=1.41, 95% C7：1.00-1.97） were independent risk factors for ARDS. Conclusion APACHE II score, septic shock, lung infection, pancreatitis and acute abdomen are early independent risk factors for ARDS in septic patients, while for those with septic shock ARDS is mainly related to the volume of fluid intake.
作者
葛建辉
GE Jianhui.(Department o f Emergency Medicine, the First Hospital of Ninghai County, Ningbo 315600, China)
出处
《浙江医学》
CAS
2017年第20期1789-1792,共4页
Zhejiang Medical Journal
关键词
脓毒症
急性呼吸窘迫综合征
早期液体复苏
Sepsis Acute respiratory distress syndrome Early fluid resuscitation
