摘要
目的探讨重症急性呼吸窘迫综合征（ARDS）的原发病、诱因、治疗预后及影响预后的因素。方法收集呼吸重症监护室2009年1月-2012年1月期间收治的重症ARDS患者34例。收集资料包括患者年龄、性别、慢性病史、诱因、确诊24h内患者的生命体征、实验室检查（血气分析、血常规、肾功能、电解质、降钙素原、C-反应蛋白、血沉、乳酸、氧合指数）、急性生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、治疗方法、与多器官功能障碍的发生以及确诊后21d病死率。比较各指标在存活组和死亡组之间的差异以及与APACHEⅡ评分的相关关系。结果入选34例重症ARDS患者中，男性28例，女性6例，年龄18～98岁，平均（54．09±18．34）岁，包括死亡患者24例（70．6％）；死亡组APACHEⅡ评分、乳酸、降钙素原高于存活组[分别为（23．42±4．59）VS（16．70±1．57），（4．83±3．60）vs（2．88±0．85）mmol／L，（3．02±2．87）vs（1．20±0．73）ng／L；P〈0．05]，氧合指数低于存活组[（80．92±29．29）vs（112．30±24．49）；P〈0．05]；APACHEⅡ评分与血乳酸、降钙素原水平正相关（r=0．531，r=0．527；P〈0．叫）。结论血乳酸及降钙素原浓度与ARDS病情严重程度正相关。以治疗原发病为主，结合对多脏器功能保护的综合治疗可改善ARDS患者的预后。
Objective To investigate the primary diseases, risk factors, therapy, prognosis and factors affecting prognosis of severe acute respiratory distress syndrome（ARDS）. Methods Data of 34 patients with severe ARDS from January 2009 to January 2012 were retrospectively analyzed, including age, gender, history of chronic diseases, predisposing factors, vital signs within 24h after diagnosis, laboratory tests （blood gas analysis, routine blood tests, renal function, electrolytes, procalcitonin, C-reactive protein, erythrocyte sedimentation, lactic acid, oxygenation index）, acute physiology and chronic health evaluation II （APACHE lI ） score, therapeutic methods, occurrence of multiple organ dysfunction （MODS） and mortality within 21d after final diagnosis. Above indicators were compared between survival and death groups and their correlation with APACHE II score was analyzed. Results Of the 34 patients with severe ARDS, there were 28 males and 6 females, ranging from 18 to 98 years [（54.09 ＋ 18.34）years], including 24 death cases（70.6%）. The statistics showed that APACHE II score, lactic acid, procalcitonin in death group were higher than those in survival group[（23.42 ± 4.59） vs （16.70 ± 1.57）, （4.83± 3.60） vs （2.88 ± 0.85）mmol/L, （3.02 ±2.87） vs （1.20 ± 0.73）ng/L; P 〈 0.05], oxygenation index in death group was lower than that in survival group[（80.92 ± 29.29） vs （112.30 ± 24.49）; P 〈 0.05]. APACHE II score was positively correlated with blood lactic acid and procalcitonin （r=-0.531, r=0.527; P 〈 0.01）. Conclusions Concentrations of blood lactic acid and procalcitonin were positively correlated with the severity of ARDS. The integrated therapy including treatment of primary diseases and protection of multiple organs can improve the prognosis of patients with ARDS.
出处
《中华老年多器官疾病杂志》
2012年第6期405-408,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
急性呼吸窘迫综合征
回顾性研究
急性生理学和慢性健康状况评分系统Ⅱ
降钙素原
乳酸
acute respiratory distress syndrome
retrospective analysis
acute physiology and chronic health evaluation U score
procalcitonin
lactic acid
