摘要
目的 :探讨急性呼吸窘迫综合征 (ARDS)病死率居高不下因素。方法 :收集 1年 8个月中因ARDS收入ICU所有患者的临床资料 (原发病或诱发因素、APACHEⅡ评分、严重程度、机械通气治疗和PEEP水平、糖皮质激素 ) ,分析各种特定危险因素与病死率之间关系 ,χ2 检验差异显著性。结果 :4 4例中 ,年龄 5～ 84岁 (5 4 .5± 2 1.5 )岁 ;肺内组病死率 93.3% (14 /15例 ) ,肺外组 4 4 .8% (13/2 9例 ) ,肺内组高于肺外组 (P <0 .0 1) ;APACHEⅡ评分≤ 2 0分组病死率低于≥ 31分组 (P <0 .0 5 ) ;以PaO2 /FiO2 和 Qs/ QT判断严重程度 ,对预后无显著影响 (P >0 .0 5 ) ;PEEP水平 6～ 10cmH2 O组病死率低于≥ 11cmH2 O组 (P <0 .0 5 ) ;机械通气治疗组病死率明显低于未接受机械通气治疗组 ,P <0 .0 5 ;34例接受不同类型激素治疗病死率 (70 .6 % )高于未接受激素治疗组 (30 .0 % ) ,差异显著 (P <0 .0 1) ,应用时间与剂量间无显著差异 (P >0 .0 5 ) ;直接死亡原因为ARDS未得到纠正者仅占 11.1% (3/2 7例 ) ,明显低于感染性休克和MODS(P <0 .0 1)。结论 :在及时应用机械通气治疗前提下 ,肺内疾病和APACHEⅡ评分≥ 31可能是预报ARDS病死率高的指标。
Objective: To study the risk factors of high mortality in patients with acute respiratory distress syndrome (ARDS). Methods: The clinical data of all patients with ARDS in Medical ICU (MICU) during May 2000 to Dec. 2001were collected and compared with outcome, prospectively, including primary diseases or precipitating factors, APACHEⅡscore, severity of diseases, mechanical ventilation, level of PEEP and usage of corticosteroids. The significance between them was evaluated by χ 2 test. Results: There were 44 cases with male 26, female 18, age 5 84 (54.54±21.5) years old. The mortality for patients with pulmonary disease was 93.3%(14/15cases)and for extrapulmonary diseases 44.8% (13/29 cases). The former was significantly higher than the latter ( P <0.01). The mortality for patients with APACHEⅡscore≤20 was lower than ≥31 significantly ( P <0.05). The severity of diseases identified by PaO 2/?FiO 2 and s/ T had no significant effects on outcome ( P >0.05). The mortality of patients on lower level (6 10 cmH 2O) PEEP was lower than that on higher level (≥11cmH 2O) significantly ( P <0.05). Among them, 34 cases had received different types or dosages of corticosteroids and the mortality (70.6%) of them was significant higher than those (30.0%) who had not treated with steroids ( P <0.01). No significant difference was found on time or dosages used ( P >0.05). Only 11.1% (3/?27 cases) of patients died of ARDS directly and was lower than that of septic shock and MODS ( P <0.01). Conclusion: The major predictor for high mortality in ARDS may be the primary pulmonary diseases and APACHE Ⅱ score ≥31 when mechanical ventilation could be used in time.
出处
《内科急危重症杂志》
2003年第3期137-140,144,共5页
Journal of Critical Care In Internal Medicine
基金
上海市卫生局科技发展基金项目资助(编号 0 0 4 0 9)
